Paula Chatterjee (
Rachel M. Werner is the Robert D. Eilers Professor of Health Care Management at the Wharton School, a professor of medicine at the Perelman School of Medicine, and executive director of the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, and core faculty at the Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, in Philadelphia, Pennsylvania.
Health Aff (Millwood). 2021 Dec;40(12):1846-1855. doi: 10.1377/hlthaff.2021.00643.
Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-in-differences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states. Nor did we see evidence of statistically significant differential improvement at critical access hospitals in expansion versus nonexpansion states on either staffing measures (physicians and registered nurses per 1,000 patient days) or quality measures (percentage-point changes in readmissions and mortality within thirty days of admission for pneumonia or heart failure). These findings suggest that critical access hospitals may need to take additional measures to bolster finances to provide continued support for the delivery of high-quality care to rural and other underserved communities.
基层医疗机构是为农村和其他服务不足社区提供医疗服务的重要机构，但它们在运营利润率较低的情况下，面临人员配备和质量挑战。医疗补助计划的扩大被发现可以广泛改善医院的财务状况，因此可能允许在这些弱势医院进行持续的人员配备和质量改进投资。在这项差异中的差异分析中，我们发现，与非扩张州的医院相比，医疗补助计划扩张州的基层医疗机构的运营利润率并没有出现统计学意义上的扩张后增长。我们也没有发现证据表明，在扩张州和非扩张州的基层医疗机构，在人员配备措施（每千名患者天的医生和注册护士人数）或质量措施（肺炎或心力衰竭患者入院后 30 天内的再入院率和死亡率的百分点变化）方面存在统计学意义上的差异改善。这些发现表明，基层医疗机构可能需要采取额外措施来加强财务状况，以继续为农村和其他服务不足社区提供高质量的医疗服务。
