Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction.
<h4>Introduction</h4>Uninsured patients have decreased access to care, lower rates of percutaneous coronary intervention (PCI), and worse outcomes after acute myocardial infarction (AMI). The aim of this study was to determine whether expanding insurance coverage through the Affordable C...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0232097 |
| _version_ | 1818928661484535808 |
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| author | Erica M Valdovinos Matthew J Niedzwiecki Joanna Guo Renee Y Hsia |
| author_facet | Erica M Valdovinos Matthew J Niedzwiecki Joanna Guo Renee Y Hsia |
| author_sort | Erica M Valdovinos |
| collection | DOAJ |
| description | <h4>Introduction</h4>Uninsured patients have decreased access to care, lower rates of percutaneous coronary intervention (PCI), and worse outcomes after acute myocardial infarction (AMI). The aim of this study was to determine whether expanding insurance coverage through the Affordable Care Act's expansion of Medicaid eligibility affected access to PCI hospitals, rates of PCI, 30-day readmissions, and in-hospital mortality after AMI.<h4>Methods</h4>Quasi-experimental, difference-in-differences analysis of Medicaid and uninsured patients with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act, and Florida, which did not, from 2010-2015. This study accounts for the early expansion of Medicaid in certain California counties that began as early as July 2011. Main outcomes included rates of admission to PCI hospitals, rates of transfer for patients who initially presented to non-PCI hospitals, rates of PCI, rates of early PCI defined as within 48 hours of hospital admission, in-hospital mortality, and 30-day readmission.<h4>Results</h4>55,991 hospital admissions between 2010-2015 met inclusion criteria. Of these, 32,540 were in California, which expanded Medicaid, and 23,451 were in Florida, which did not. 30-day readmission rates after AMI decreased by an absolute difference of 1.22 percentage points after the Medicaid expansion (95% CI -2.14 to -0.30, P < 0.01). This represented a relative decrease in readmission rates of 9.5% after AMI. No relationship between the Medicaid expansion and admission to PCI hospitals, transfer to PCI hospitals, rates of PCI, rates of early PCI, or in-hospital mortality were observed.<h4>Conclusions</h4>Hospital readmissions decreased by 9.5% after the Affordable Care Act expanded Medicaid eligibility, although there was no association found between Medicaid expansion and access to PCI hospitals or treatment with PCI. Better understanding the ways that Medicaid expansion might affect care for vulnerable populations with AMI is important for policymakers considering whether to expand Medicaid eligibility in their state. |
| first_indexed | 2024-12-20T03:32:27Z |
| format | Article |
| id | doaj.art-35831e6ce11545eb80c2b125e0b7641d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T03:32:27Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-35831e6ce11545eb80c2b125e0b7641d2022-12-21T19:54:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01154e023209710.1371/journal.pone.0232097Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction.Erica M ValdovinosMatthew J NiedzwieckiJoanna GuoRenee Y Hsia<h4>Introduction</h4>Uninsured patients have decreased access to care, lower rates of percutaneous coronary intervention (PCI), and worse outcomes after acute myocardial infarction (AMI). The aim of this study was to determine whether expanding insurance coverage through the Affordable Care Act's expansion of Medicaid eligibility affected access to PCI hospitals, rates of PCI, 30-day readmissions, and in-hospital mortality after AMI.<h4>Methods</h4>Quasi-experimental, difference-in-differences analysis of Medicaid and uninsured patients with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act, and Florida, which did not, from 2010-2015. This study accounts for the early expansion of Medicaid in certain California counties that began as early as July 2011. Main outcomes included rates of admission to PCI hospitals, rates of transfer for patients who initially presented to non-PCI hospitals, rates of PCI, rates of early PCI defined as within 48 hours of hospital admission, in-hospital mortality, and 30-day readmission.<h4>Results</h4>55,991 hospital admissions between 2010-2015 met inclusion criteria. Of these, 32,540 were in California, which expanded Medicaid, and 23,451 were in Florida, which did not. 30-day readmission rates after AMI decreased by an absolute difference of 1.22 percentage points after the Medicaid expansion (95% CI -2.14 to -0.30, P < 0.01). This represented a relative decrease in readmission rates of 9.5% after AMI. No relationship between the Medicaid expansion and admission to PCI hospitals, transfer to PCI hospitals, rates of PCI, rates of early PCI, or in-hospital mortality were observed.<h4>Conclusions</h4>Hospital readmissions decreased by 9.5% after the Affordable Care Act expanded Medicaid eligibility, although there was no association found between Medicaid expansion and access to PCI hospitals or treatment with PCI. Better understanding the ways that Medicaid expansion might affect care for vulnerable populations with AMI is important for policymakers considering whether to expand Medicaid eligibility in their state.https://doi.org/10.1371/journal.pone.0232097 |
| spellingShingle | Erica M Valdovinos Matthew J Niedzwiecki Joanna Guo Renee Y Hsia Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. PLoS ONE |
| title | Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. |
| title_full | Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. |
| title_fullStr | Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. |
| title_full_unstemmed | Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. |
| title_short | Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction. |
| title_sort | effects of medicaid expansion on access treatment and outcomes for patients with acute myocardial infarction |
| url | https://doi.org/10.1371/journal.pone.0232097 |
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