Division of Cardiovascular Medicine (GYJ) and Department of Medicine (JWU), Beth Israel Deaconess Medical Center, Boston, MA. Cardiology Division, Massachusetts General Hospital, Boston, MA (JHW). Harvard Medical School, Boston, MA (GYJ, JWU, JHW).
Circ Cardiovasc Qual Outcomes. 2023 Jun;16(6):e009753. doi: 10.1161/CIRCOUTCOMES.122.009753. Epub 2023 Jun 20.
The goal of the Affordable Care Act was to improve health outcomes through expanding insurance, including through Medicaid expansion. We systematically reviewed the available literature on the association of Affordable Care Act Medicaid expansion with cardiac outcomes.
Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed systematic searches in PubMed, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature using the keywords such as Medicaid expansion and cardiac, cardiovascular, or heart to identify titles published from 1/2014 to 7/2022 that evaluated the association between Medicaid expansion and cardiac outcomes.
A total of 30 studies met inclusion and exclusion criteria. Of these, 14 studies (47%) used a difference-in-difference study design and 10 (33%) used a multiple time series design. The median number of postexpansion years evaluated was 2 (range, 0.5-6) and the median number of expansion states included was 23 (range, 1-33). Commonly assessed outcomes included insurance coverage of and utilization of cardiac treatments (25.0%), morbidity/mortality (19.6%), disparities in care (14.3%), and preventive care (41.1%). Medicaid expansion was generally associated with increased insurance coverage, reduction in overall cardiac morbidity/mortality outside of acute care settings, and some increase in screening for and treatment of cardiac comorbidities.
Current literature demonstrates that Medicaid expansion was generally associated with increased insurance coverage of cardiac treatments, improvement in cardiac outcomes outside of acute care settings, and some improvements in cardiac-focused prevention and screening. Conclusions are limited because quasi-experimental comparisons of expansion and nonexpansion states cannot account for unmeasured state-level confounders.
平价医疗法案的目标是通过扩大保险范围来改善健康结果，包括通过扩大医疗补助。我们系统地回顾了关于平价医疗法案医疗补助扩张与心脏结局关联的现有文献。
根据系统评价和荟萃分析的首选报告项目的要求，我们在 PubMed、Cochrane 图书馆和 Cumulative Index to Nursing and Allied Health Literature 中使用了“医疗补助扩张”和“心脏”、“心血管”或“心脏”等关键词进行了系统搜索，以确定自 2014 年 1 月至 2022 年 7 月发表的评估医疗补助扩张与心脏结局之间关联的标题。
共有 30 项研究符合纳入和排除标准。其中，14 项研究（47%）采用了差异法研究设计，10 项研究（33%）采用了多次时间序列设计。评估扩张后年份的中位数为 2 年（范围为 0.5-6 年），纳入扩张州的中位数为 23 个（范围为 1-33 个）。常见的评估结果包括心脏治疗的保险覆盖范围和利用情况（25.0%）、发病率/死亡率（19.6%）、护理差异（14.3%）和预防保健（41.1%）。医疗补助扩张通常与保险覆盖范围增加、急性护理环境外整体心脏发病率/死亡率降低以及心脏合并症筛查和治疗的某些增加有关。
目前的文献表明，医疗补助扩张通常与心脏治疗的保险覆盖范围增加、急性护理环境外心脏结局改善以及心脏重点预防和筛查的某些改善有关。由于对扩张和非扩张州的准实验比较不能解释未测量的州级混杂因素，因此结论是有限的。
