Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;53(4):2446-2469.
doi: 10.1111/1475-6773.12734. Epub 2017 Jun 30.

Changes in Hospital Inpatient Utilization Following Health Care Reform

Gary Pickens  1 , Zeynal Karaca  2 , Eli Cutler  3 , Michael Dworsky  4 , Christine Eibner  5 , Brian Moore  6 , Teresa Gibson  6 , Sharat Iyer  7   8 , Herbert S Wong  2
Affiliations

Changes in Hospital Inpatient Utilization Following Health Care Reform

Gary Pickens et al. Health Serv Res. 2018 Aug.

Abstract

Objective: To estimate the effects of 2014 Medicaid expansions on inpatient outcomes.

Data sources: Health Care Cost and Utilization Project State Inpatient Databases, 2011-2014; population and unemployment estimates.

Study design: Retrospective study estimating effects of Medicaid expansions using difference-in-differences regression. Outcomes included total admissions, referral-sensitive surgical and preventable admissions, length of stay, cost, and patient illness severity.

Findings: In 2014 quarter four, compared with nonexpansion states, Medicaid admissions increased (28.5 percent, p = .006), and uninsured and private admissions decreased (-55.1 percent, p = .001, and -6.6 percent, p = .052), whereas all-payer admissions showed little change. Uninsured expansion effects were negative for preventable admissions (-24.4 percent, p = .068), length of stay (-9.3 percent, p = .039), total cost (-9.2 percent, p = .128), and illness severity (-4.5 percent, p = .397). Significant positive expansion effects were found for Medicaid referral-sensitive surgeries (11.8 percent, p = .021) and patient illness severity (2.3 percent, p = .015). Private and all-payer expansion effects for outcomes other than admission volume were small and mainly nonsignificant (p > .05).

Conclusion: Medicaid expansions did not change all-payer admission volumes, but they were associated with increased Medicaid and decreased uninsured volumes. Results suggest those previously uninsured with greater needs for inpatient services were most likely to gain coverage. Compositional changes in uninsured and Medicaid admissions may be due to selection.

Keywords: Affordable Care Act; Medicaid expansion; inpatient care; medically uninsured.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Observed Trends for Selected Study Outcomes by State Medicaid Expansion Status and Payment Source, 2011–2014

  1. Abbreviations: Q, quarter, NEXP, nonexpansion State; EXP, Expansion State.

  2. Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

Figure 2
Figure 2
Expansion Effects for Study Outcomes: Medicaid and Uninsured, 2014, Quarters 1–4

  1. Note. Error bars represent 95% confidence intervals for expansion effects.

  2. Abbreviations: Q, quarter; Ref. Sens., Referral‐Sensitive Surgery; Admit, Admission.

  3. Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

Figure 3
Figure 3
Expansion Effects for Study Outcomes: Private and All‐Payers, 2014, Quarters 1–4

  1. Note. Error bars represent 95% confidence intervals for expansion effects.

  2. Abbreviations: Q, quarter; Ref. Sens., Referral‐Sensitive Surgery; Admit, Admission.

  3. Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

See this image and copyright information in PMC

References

    1. Assistant Secretary for Planning and Evaluation . 2016. “Health Insurance Coverage and the Affordable Care Act, 2010–2016” [accessed on March 25, 2016]. Available at https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf
    1. Baicker, K. , Taubman S. L., Allen H. L., Bernstein M., Gruber J. H., Newhouse J. P., Schneider E. C., Wright B. J., Zaslavsky A. M., Finkelstein A. N., Oregon Health Study Group , Carlson M., Edlund T., Gallia C., and Smith J.. 2013. “The Oregon Experiment—Effects of Medicaid on Clinical Outcomes.” New England Journal of Medicine 368: 1713–22. - PMC - PubMed
    1. Barrett, M. , Lopez‐Gonzalez L., Hines A., Andrews R., and Jiang J.. 2014. “An Examination of Expected Payer Coding in HCUP Databases.” HCUP Methods Series Report #2014‐03. U.S. Agency for Healthcare Research and Quality [accessed on November 18, 2015]. Available at http://www.hcup-us.ahrq.gov/reports/methods/2014-03.pdf
    1. Bazzoli, G. 2016. “Effects of Expanded California Health Coverage on Hospitals: Implications for ACA Medicaid Expansions.” Health Services Research 51: 1368–87. - PMC - PubMed
    1. Billings, J. 2003. “Using Administrative Data to Monitor Access, Identify Disparities, and Assess Performance of the Safety Net” In Tools for Monitoring the Health Care Safety Net. Rockville, MD: Agency for Healthcare Research and Quality; Available at http://archive.ahrq.gov/data/safetynet/billings.htm

Publication types

MeSH terms

LinkOut - more resources