Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA.
Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA.
Med Care. 2022 May 1;60(5):342-350. doi: 10.1097/MLR.0000000000001703.
A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them.
The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them.
We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009-2019 data from the AMA Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion.
A total of 32,102 new general internists.
Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203-540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states.
States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.
最近的一项研究发现，在《平价医疗法案》（ACA）下扩大医疗补助的州获得了新的普通内科医生，他们正在开设自己的第一家诊所，而没有扩大医疗补助的州则失去了这些医生。
本研究旨在考察获得新医生的扩张州和失去医生的非扩张州的地区社会劣势程度。
我们使用美国社区调查数据将通勤区分为高、中、低社会劣势。利用 AMA 医师主文件 2009-2019 年的数据和各州医疗补助扩张状况的信息，我们估计了条件逻辑回归模型，以比较扩张后 6 年内新医生的所在地与扩张前 5 年内的所在地。
共 32102 名新的普通内科医生。
与扩张前的模式相比，扩张后新的普通内科医生更有可能在扩张州执业，这一发现适用于高、中、低劣势地区。我们估计，在 2014 年至 2019 年期间，非扩张州向扩张州流失了 371 名新的普通内科医生（95%置信区间，203-540）。然而，尽管高劣势地区仅占非扩张州人口的 17.9%，但这些地区流失的医生中有 62.5%是非扩张州流失的。
选择不扩大医疗补助的州将新的普通内科医生输给了扩张州。非扩张州流失的医生中，有很大一部分是从高劣势地区流失的，这可能会影响所有居民的获得医疗服务的机会，而不论其是否有保险。
