Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

Health Research Policy and Systems

Elizabeth A. Brown¹  Walter J. Jones²  Kit N. Simpson²  Mulugeta Gebregziabher³  Brandi M. White⁴ 

[1] Department of Clinical Sciences, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Avenue, MSC 962, 29425, Charleston, SC, USA;Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, 29425, Charleston, SC, USA;Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, 29425, Charleston, SC, USA;Division of Health Sciences, Education, and Research, College of Health Sciences, University of Kentucky, Room 209C Wethington Building, 900 South Limestone Street, 40536-0200, Lexington, KY, USA;

关键词: Access;    Primary care;    Medicaid;    Patient Protection and Affordable Care Act;    Health policy;    Interrupted time series analysis;   

DOI  :  10.1186/s12961-021-00730-0

来源: Springer

【 摘 要 】

BackgroundThe Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.MethodsWe performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates.ResultsThe Affordable Care Act’s Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: −0.0059, CI −0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care).ConclusionHealth policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents.Contribution to knowledgeAmbulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers’ motivations and objectives, etc.) must be addressed to improve access.

【 授权许可】

CC BY