Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012–2015

BMC Health Services Research

Research Article

Aaron Parzuchowski¹  John N. Mafi²  Rong Guo²  Chi-Hong Tseng²  Carlos Oronce³  A. Mark Fendrick⁴ 

[1] Department of Veteran Affairs, National Clinician Scholars Program, Ann Arbor, MI, USA;Division of General Medicine, University of Michigan, Ann Arbor, MI, USA;Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA;Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA;VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA;Division of General Medicine, University of Michigan, Ann Arbor, MI, USA;

关键词: Quality;    Value;    Medicaid;    Ambulatory care;    Health policy;    Affordable care act;   

DOI  :  10.1186/s12913-023-09696-x

 received in 2023-01-04, accepted in 2023-06-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWhile the Affordable Care Act’s Medicaid expansion improved healthcare coverage and access for millions of uninsured Americans, less is known about its effects on the overall accessibility and quality of care across all payers. Rapid volume increases of newly enrolled Medicaid patients might have unintentionally strained accessibility or quality of care. We assessed changes in physician office visits and high- and low-value care associated with Medicaid expansion across all payers.MethodsPrespecified, quasi-experimental, difference-in-differences analysis pre and post Medicaid expansion (2012–2015) in 8 states that did and 5 that did not choose to expand Medicaid. Physician office visits sampled from the National Ambulatory Medical Care Survey, standardized with U.S. Census population estimates. Outcomes included visit rates per state population and rates of high or low-value service composites of 10 high-value measures and 7 low-value care measures respectively, stratified by year and insurance.ResultsWe identified approximately 143 million adults utilizing 1.9 billion visits (mean age 56; 60% female) during 2012–2015. Medicaid visits increased in expansion states post-expansion compared to non-expansion states by 16.2 per 100 adults (p = 0.031 95% CI 1.5–31.0). New Medicaid visits increased by 3.1 per 100 adults (95% CI 0.9–5.3, p = 0.007). No changes were observed in Medicare or commercially-insured visit rates. High or low-value care did not change for any insurance type, except high-value care during new Medicaid visits, which increased by 4.3 services per 100 adults (95% CI 1.1–7.5, p = 0.009).ConclusionsFollowing Medicaid expansion, the U.S. healthcare system increased access to care and use of high-value services for millions of Medicaid enrollees, without observable reductions in access or quality for those enrolled in other insurance types. Provision of low-value care continued at similar rates post-expansion, informing future federal policies designed to improve the value of care.

【 授权许可】

CC BY   
© The Author(s) 2023

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