Department of Health Policy and Administration, Penn State University, Monaca, Pennsylvania, USA.
Department of Health Policy and Management, Texas A&M University, School of Public Health, College Station, Texas, USA.
Health Serv Res. 2024 Aug;59(4):e14334. doi: 10.1111/1475-6773.14334. Epub 2024 Jun 3.
To examine the impact of the Affordable Care Act (ACA) health insurance exchanges (Marketplace) on the rate of uninsured discharges in Texas.
Secondary discharge data from 2011 to 2019 from Texas.
We conducted a retrospective study estimating the effects of the ACA Marketplace using difference-in-difference regressions, with the main outcome being the uninsured discharge rate. We stratified our sample by patient's race, age, gender, urbanicity, major diagnostic categories (MDC), and emergent type of admissions.
DATA COLLECTION/EXTRACTION METHODS: We used Texas hospital discharge records for non-elderly adults collected by the state of Texas and included acute care hospitals who reported data from 2011 to 2019.
The expansion of insurance through ACA Marketplaces led to reductions in the uninsured discharge rate by 9.9% (95% CI, -17.5%, -2.3%) relative to the baseline mean. The effects of the ACA were felt strongest in counties with any share of Hispanic, in counties with a larger population of Black, and other racial groups, in counties with a significant share of female and older age individuals, in counties considered to be urban, in high-volume diagnoses, and emergent type of admissions.
These findings indicate that the ACA facilitated a shift in hospital payor mix from uninsured to insured.
研究平价医疗法案（ACA）医疗保险交易所（市场）对德克萨斯州未参保出院率的影响。
来自德克萨斯州 2011 年至 2019 年的二次出院数据。
我们使用差分法回归进行了一项回顾性研究，以估计 ACA 市场的影响，主要结果是未参保出院率。我们根据患者的种族、年龄、性别、城市、主要诊断类别（MDC）和急症入院类型对样本进行分层。
数据收集/提取方法：我们使用德克萨斯州收集的非老年成年人的医院出院记录，包括报告了 2011 年至 2019 年数据的急性护理医院。
ACA 通过市场扩大保险范围，使未参保出院率相对基线平均水平降低了 9.9%（95%置信区间，-17.5%，-2.3%）。ACA 的影响在任何比例的西班牙裔、黑人和其他种族群体比例较大、女性和年龄较大的人群比例较大、被认为是城市的县、高容量诊断和急症入院的县中感受最强烈。
这些发现表明，ACA 促进了医院付款人组合从未参保到参保的转变。
