Effects of Affordable Care Act on uninsured hospitalization: Evidence from Texas

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-06-03 DOI:10.1111/1475-6773.14334

Nima Khodakarami PhD, Benjamin Ukert PhD

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引用次数: 0

Abstract

Objective

To examine the impact of the Affordable Care Act (ACA) health insurance exchanges (Marketplace) on the rate of uninsured discharges in Texas.

Data Source and Study Setting

Secondary discharge data from 2011 to 2019 from Texas.

Study Design

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.

Principal Findings

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.

Conclusions

These findings indicate that the ACA facilitated a shift in hospital payor mix from uninsured to insured.

Abstract Image

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平价医疗法案》对无保险住院治疗的影响：得克萨斯州的证据。

目标：研究平价医疗法案（ACA）健康保险交易所（Marketplace）对得克萨斯州无保险出院率的影响：研究设计：我们进行了一项回顾性研究，使用差分回归法估算 ACA 市场的影响，主要结果是无保险出院率。我们按照患者的种族、年龄、性别、城市化程度、主要诊断类别（MDC）和入院急诊类型对样本进行了分层：我们使用了德克萨斯州收集的非老年成人出院记录，包括2011年至2019年期间报告数据的急症医院：通过 ACA Marketplaces 扩大保险范围使无保险出院率相对于基线平均值降低了 9.9% (95% CI, -17.5%, -2.3%)。在西班牙裔人口比例较高的县，在黑人和其他种族人口较多的县，在女性和老年人口比例较高的县，在被认为是城市的县，在高诊断量和紧急入院类型的县，ACA 的效果最为明显：这些研究结果表明，《美国医疗保险法》促进了医院支付方组合从无保险向有保险的转变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.