Abstract
Background
Previous work has shown that the Affordable Care Act (ACA) Medicaid expansion decreased
the uninsured rate and improved some trauma outcomes among young adult trauma patients,
but no studies have investigated the impact of ACA Medicaid expansion on secondary
overtriage, namely the unnecessary transfer of non-severely injured patients to tertiary
trauma centers.
Methods
Statewide hospital inpatient and emergency department discharge data from two Medicaid
expansion and one non-expansion state were used to compare changes in insurance coverage
and secondary overtriage among trauma patients aged 19-44 y transferred into a level
I or II trauma center before (2011-2013) to after (2014-quarter 3, 2015) Medicaid
expansion. Difference-in-difference (DD) analyses were used to compare changes overall,
by race/ethnicity, and by ZIP code-level median income quartiles.
Results
Medicaid expansion was associated with a decrease in the proportion of patients uninsured
(DD: -4.3 percentage points; 95% confidence interval (CI): -7.4 to -1.2), an increase
in the proportion of patients insured by Medicaid (DD: 8.2; 95% CI: 5.0 to 11.3),
but no difference in the proportion of patients who experienced secondary overtriage
(DD: -1.5; 95% CI: -4.8 to 1.8). There were no differences by race/ethnicity or community
income level in the association of Medicaid expansion with secondary overtriage.
Conclusions
In the first 2 y after ACA Medicaid expansion, insurance coverage increased but secondary
overtriage rates were unchanged among young adult trauma patients transferred to level
I or II trauma centers.
Keywords
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Article info
Publication history
Accepted:
October 24,
2022
Received in revised form:
September 1,
2022
Received:
May 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.