Highlights
- •We found a smaller decrease in surgical utilization in a population with Affordable Care Act-related Medicaid expansion compared to one without.
- •The divergence of trends in this study was driven by increased utilization of discretionary surgery.
- •We observed an increase in Medicaid coverage among patients undergoing surgery.
Abstract
Background
We aim to understand how Medicaid expansion under the ACA has affected utilization
of surgical services.
Methods
The State Inpatient Databases were used to compare utilization of a broad array of
surgical procedures among nonelderly adults (aged 19–64 years) in a multistate population
that experienced ACA-related Medicaid expansion to one that did not. We performed
a difference-in-differences (DID) analysis to determine the effect of Medicaid expansion
on utilization of surgical services from 2012 to 2014.
Results
There were 259,061 cases identified in the Medicaid expansion population and 261,269
in the control population. In the expansion group, there was a smaller decrease in
utilization - by a margin of 21.68 cases per 100,000 individuals (p < 0.001). Percent
of surgical patients covered by Medicaid increased among the expansion group from
12.00% to 15.48% (DID = 3.93%; p < 0.001).
Conclusions
Year one of Medicaid expansion under the ACA was associated with a modest but statistically
significant difference in utilization of surgical services as well as an increase
in percent of surgery patients covered by Medicaid.
Keywords
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Article info
Publication history
Published online: December 28, 2019
Accepted:
December 13,
2019
Received in revised form:
December 11,
2019
Received:
October 11,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
