Affordable Care Act and healthcare delivery: A comparison of California and Florida hospitals and emergency departments

作者：Barakat Monique T; Mithal Aditi; Huang Robert J; Mithal Alka; Sehgal Amrita; Banerjee Subhas; Singh Gurkirpal^*

来源：PLos One, 2017, 12(8): e0182346.

DOI：10.1371/journal.pone.0182346

Importance
The Affordable Care Act (ACA) has expanded access to health insurance for millions of Americans, but the impact of Medicaid expansion on healthcare delivery and utilization remains uncertain.
Objective
To determine the early impact of the Medicaid expansion component of ACA on hospital and ED utilization in California, a state that implemented the Medicaid expansion component of ACA and Florida, a state that did not.
Design
Analyze all ED encounters and hospitalizations in California and Florida from 2009 to 2014 and evaluate trends by payer and diagnostic category. Data were collected from State Inpatient Databases, State Emergency Department Databases and the California Office of Statewide Health Planning and Development.
Setting
Hospital and ED encounters.
Participants
Population-based study of California and Florida state residents.
Exposure
Implementation of Medicaid expansion component of ACA in California in 2014.
Main outcomes or measures
Changes in ED visits and hospitalizations by payer, percentage of patients hospitalized after an ED encounter, top diagnostic categories for ED and hospital encounters.
Results
In California, Medicaid ED visits increased 33% after Medicaid expansion implementation and self-pay visits decreased by 25% compared with a 5.7% increase in the rate of Medicaid patient ED visits and a 5.1% decrease in rate of self-pay patient visits in Florida. In addition, California experienced a 15.4% increase in Medicaid inpatient stays and a 25% decrease in self pay stays. Trends in the percentage of patients admitted to the hospital from the ED were notable; a 5.4% decrease in hospital admissions originating from the ED in California, and a 2.1% decrease in Florida from 2013 to 2014.
Conclusions and relevance
We observed a significant shift in payer for ED visits and hospitalizations after Medicaid expansion in California without a significant change in top diagnoses or overall rate of these ED visits and hospitalizations. There appears to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.

• 出版日期2017-8-3