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- Title
Effects of Expanded California Health Coverage on Hospitals: Implications for ACA Medicaid Expansions.
- Authors
Bazzoli, Gloria J.
- Abstract
<bold>Objective: </bold>To assess the effects on hospitals of early California actions to expand insurance coverage for low-income uninsured adults after passage of the Affordable Care Act.<bold>Data Sources/study Setting: </bold>Data from the California Office of Statewide Health Planning and Development and the California Department of Health were merged with U.S. census data for 294 short-term general hospitals during the period 2009-2012.<bold>Study Design: </bold>A difference-in-difference analysis was conducted with hospitals in counties that did not implement insurance expansions used as a comparison group. Variables examined included payer mix, costs of unreimbursed care, and hospital operating margin. Sensitivity analyses were conducted as well as a triple difference analysis. Effects were estimated for hospitals overall and by ownership type.<bold>Principal Findings: </bold>California insurance expansions primarily benefited for-profit hospitals, with these facilities experiencing significant decreases in self-pay patients, increases in county-covered patients, and reductions in charity care. Most models yielded no significant change in payer mix and conflicting changes in unreimbursed care for nonprofit hospitals.<bold>Conclusions: </bold>California hospitals that treated the most uninsured prior to insurance expansions did not as a group experience substantial benefit in terms of reduced uninsured burden or better financial performance after program expansions occurred.
- Subjects
CALIFORNIA; UNITED States; HEALTH behavior; HEALTH facilities; PUBLIC health; MEDICAL care; CANCER hospitals; HOSPITALS &; economics; MEDICAID; ECONOMIC impact; INSURANCE statistics; HOSPITAL statistics; POVERTY; PUBLIC hospitals; PATIENT Protection &; Affordable Care Act; ECONOMICS
- Publication
Health Services Research, 2016, Vol 51, Issue 4, p1368
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12414