Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases.
Adolescent
Adult
Aged
Child
Child, Preschool
Emergency Service, Hospital
Florida
/ epidemiology
Gastrointestinal Diseases
/ epidemiology
Hospitalization
Humans
Infant
Infant, Newborn
Liver Diseases
/ epidemiology
Medicaid
Middle Aged
Pancreatic Diseases
/ epidemiology
Patient Protection and Affordable Care Act
United States
/ epidemiology
Young Adult
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
5
10
2018
medline:
1
6
2021
entrez:
5
10
2018
Statut:
ppublish
Résumé
The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases. We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not). From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida. We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.
Sections du résumé
BACKGROUND
The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.
METHODS
We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).
RESULTS
From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.
CONCLUSIONS
We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.
Identifiants
pubmed: 30285976
doi: 10.1097/MCG.0000000000001102
pmc: PMC7372922
mid: NIHMS1500156
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e21-e29Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK007056
Pays : United States
Références
JAMA. 2016 Aug 2;316(5):492-3
pubmed: 27399990
N Engl J Med. 2011 Sep 22;365(12):e25
pubmed: 21899444
PLoS One. 2017 Aug 3;12(8):e0182346
pubmed: 28771602
Am J Gastroenterol. 2013 Sep;108(9):1496-507
pubmed: 23857475
JAMA. 2016 Aug 2;316(5):497-9
pubmed: 27400390
Acad Emerg Med. 2014 Oct;21(10):1135-42
pubmed: 25308137
JAMA. 2016 Aug 2;316(5):525-32
pubmed: 27400401
JAMA. 2016 Aug 2;316(5):495-7
pubmed: 27400269
Health Aff (Millwood). 2010 Sep;29(9):1630-6
pubmed: 20820018
JAMA. 2010 Aug 11;304(6):664-70
pubmed: 20699458
Postgrad Med J. 2008 Sep;84(995):454-8
pubmed: 18940946
Gastroenterology. 2015 Dec;149(7):1731-1741.e3
pubmed: 26327134
Int J Gen Med. 2014 Mar 13;7:159-73
pubmed: 24648750
Int J Health Care Finance Econ. 2014 Dec;14(4):289-310
pubmed: 25005072
Clin Gastroenterol Hepatol. 2015 Nov;13(12):2166-72
pubmed: 26192145