The Impact of Payment Reform on Utilization of Reconstructive Surgery
Notice bibliographique
Résumé
PURPOSE: Medicaid beneficiaries systematically face challenges in accessing healthcare, especially with regard to specialty services such as reconstructive surgery. In January 2014, the Affordable Care Act (ACA) took effect, allowing states to expand Medicaid eligibility. Concurrently, Maryland also launched statewide global budgeting of hospitals, intended to control healthcare costs.1 However, the impact of such reform on utilization of reconstructive procedures has not been characterized. This study evaluated the impact of Medicaid expansion and global hospital budgeting on utilization of 3 common reconstructive procedures (reconstructive breast surgery, maxillofacial surgery, and hand surgery) by marginalized populations (Medicaid/uninsured patients). MATERIALS AND METHODS: Adults in New Jersey (Medicaid expansion state), Maryland (expansion state with global hospital budgeting), and Florida (non-expansion state) undergoing the selected reconstructive procedures between 2012-2016 were tabulated using Healthcare Costs and Utilization Project State Ambulatory Surgery and Services and State Inpatient Databases. Interrupted time-series analyses were used to evaluate the impact of policy reform on reconstructive surgery utilization by marginalized patients. RESULTS: During the study period, 96,662 Medicaid/uninsured patients underwent the selected reconstructive procedures in the 3 states. The likelihood of Medicaid being listed as the primary payer for patients undergoing reconstructive surgery significantly increased in expansion states (Maryland absolute policy effect: 0.02% per quarter, 95% confidence interval: 0.01% to 0.02% per quarter; New Jersey absolute policy effect: 0.04% per quarter, 95% confidence interval 0.02%–0.05%) when compared to Florida (non-expansion state). There was also an immediate policy effect: within 1 year of ACA implementation, there was a significant increase in the proportion of Medicaid beneficiaries undergoing the reconstructive procedures (Maryland, 0.03%, 95% CI, 0.01%–0.05%; New Jersey, 0.01%, 95% CI, 0.01%–0.02%), whereas there was a significant decline in the proportion of uninsured patients (Maryland, −0.01%, 95% CI, −0.01% to 0.0%; New Jersey, −0.008%, 95% CI, −0.01% to −0.006%). Trends in Maryland versus New Jersey were compared with understand the impact of global hospital budgeting. Global budgeting did not significantly impact overall utilization of reconstructive procedures amongst Medicaid beneficiaries, though there was an increase in utilization of emergent/urgent reconstructive procedures that reached borderline significance (0.03% per quarter; 95% CI, 0.0%–0.05%). CONCLUSIONS: Medicaid beneficiaries experienced an increased utilization of reconstructive surgery post-ACA in expansion states when compared with nonexpansion states, mirroring trends in other areas of healthcare. Increased utilization by Medicare beneficiaries was not completely offset by decreases in utilization by uninsured patients, suggesting that the ACA expanded access to reconstructive surgery. It was encouraging that global hospital budgeting did not limit utilization of reconstructive procedures by Medicaid beneficiaries. In fact, utilization of emergent/urgent procedures among marginalized patients in globally budgeted hospitals increased, perhaps as a result of greater incentives for hospitals to connect vulnerable/high-risk patients to the care they need under this system. REFERENCE: 1. Rajkumar R, Patel A, Murphy K, et al. Maryland’s all-payer approach to delivery-system reform. N Engl J Med. 2014;370:493.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».