Dissertation/Thesis Abstract

Assessing the Spillover Effects of Medicaid Expansion Compared to Non-expansion on Existing Medicaid Enrollees, Children of Medicaid Eligible Parents, and on the Commercially-insured Population
by Kathe, Niranjan, Ph.D., University of Arkansas for Medical Sciences, 2019, 263; 22588584
Abstract (Summary)

The overarching goal of this course of research is to assess the early spillover effects of Medicaid expansion (compared to non-expansion), on access to care for existing Medicaid enrollees and children of Medicaid eligible parents, inpatient hospital treatment intensity and utilization of emergency department (ED), physician office, and urgent care center(UCC) visit among commercially-insured population.

The study used a longitudinal study design with a difference in difference analysis to determine the impact of Medicaid expansion on access to care for existing Medicaid patients and children of Medicaid eligible parents. On the other hand, the study used repeated cross-sectional design with a difference in difference analysis to determine the impact of Medicaid expansion on inpatients treatment intensity and utilization of non-emergent ED, physician office, and UCC visit among the commercially-insured population.

The study found that Medicaid expansion was associated with no significant changes in access to care for existing Medicaid enrollees and children of Medicaid eligible parents. On the other hand, the study found that Medicaid expansion was associated with reduced inpatient treatment intensity for maternity-related hospitalizations among the commercially-insured population. Lastly, the study found that Medicaid expansion was associated with changes in the mix of treatment setting among commercially-insured, namely, reduction in non-emergent ED and UCC visits, and an increase in physician office visits.

The study found that the spillover effects of Medicaid expansion have been mixed. Firstly, the study did not find evidence for negative spillovers namely reduction in access to care for existing Medicaid enrollees, and for positive spillover effects namely increased access to care for children of Medicaid eligible parents. Secondly, the study found a positive spillover among commercially-insured population, namely, reduced inpatient treatment intensity for maternity-related hospitalizations, increased physician office spending, and a simultaneous reduction in non-emergent ED and UCC visits. The net effect of these spillovers may result in some downstream cost savings for commercial payers and subsequently affect the premiums for the commercially-insured population. Thus, repeal or rollback of Medicaid expansion may also affect the spending and premiums for the commercially-insured population.

Indexing (document details)
Advisor: Painter, Jacob T.
Commitee: Martin, Bradley C., Li, Chenghui, Goudie, Anthony, McAdam-Marx, Carrie
School: University of Arkansas for Medical Sciences
Department: Pharmaceutical Sciences
School Location: United States -- Arkansas
Source: DAI-A 81/2(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Pharmaceutical sciences, Public policy
Keywords: Access to care, Affordable care act, Medicaid expansion, Spillover effect
Publication Number: 22588584
ISBN: 9781085692632
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