1. In this repeated cross-sectional study, there were no significant differences observed between hospital discharges before or after the implementation of Medicaid and Medicare.
2. The ACA implementation, similarly, did not significantly increase mean days in hospital or hospital discharges across the study population.
Evidence Rating Level: 3 (Average)
Study Rundown: This repeated cross-sectional study examined how the implementation of Medicare, Medicaid and the ACA impacted hospital utilization. It was hypothesized that increased coverage could increase hospital use, as uninsured persons may often avoid the hospital due to the potential costs of hospitalization and emergency room visits. Interestingly, though the hospital days were unchanged during the first two years following implementation of the ACA, Medicare and Medicaid, but increased subsequently. However, a major limitation of this study was that participant recall was utilized for data collection. Furthermore, the follow up for the ACA was also limited. Despite these limitations, the results of the study indicate that previous expansions in healthcare coverage in the United States were not associated with changes in hospital use across the country.
In-Depth [cross-sectional study]: In this repeated cross-sectional study, the relationship between the two largest coverage expansions in the United States and hospital use was examined. These expansions include the implementation of Medicare and Medicaid in July 1966 as well as the Patient Protection and Affordable Care Act (ACA) in 2014. The primary outcomes of the study were mean hospital discharges and days both society-wide and among subgroups based on income, age and health status. A multivariable negative binomial regression was utilized to analyze the changes between these groups pre and post healthcare coverage expansion. Following analysis, no significant increase was observed following either the implementation of Medicare and Medicaid or ACA. Regarding the ACA expansion, adjusted analyses showed an insignificant decrease in discharges of 0.6 (CI, -0.2 to 1.3) per 100 persons (P = 0.133) following the expansion. A decrease in hospital days of 7.3 (CI, -0.3 to 14.8) per 100 persons (P = 0.060) was also observed post expansion. For Medicare and Medicaid, the number of discharges were unchanged following expansion, with the overall population averaging 12.8 discharges per 100 persons before expansion and 12.7 per 100 persons post expansion. Similarly, a nonsignificant decrease in hospital days was observed.
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