美国雪松西奈山医疗中心Hiroshi Gotanda小组的一项最新研究分析了美国扩大医疗补助后低收入成年人的自费支出和经济负担。2020年2月5日，《英国医学杂志》发表了这项成果。

为了探讨《平价医疗法案》扩大医疗补助项目与政策实施的前四年（2014-17年）低收入成年人医疗支出之间的关联，研究小组对19-64岁、家庭收入低于联邦贫困水平138%的37819名参与者进行了一项全国代表性的抽样调查。

结果显示，医疗支出在前两年没有变化，但扩大医疗补助后，参与者的自费支出显著降低，平均减少了122美元（28%）；自费支出加保费支出亦显著降低，减少了442美元（29%）；第三到四年经历灾难性财务负担的可能性降低了4.7个百分点。没有证据表明，在扩大医疗补助后，保费支出发生变化。

总之，《平价医疗法案》扩大医疗补助，降低了低收入成年人的自费支出和灾难性财务负担，成功改善了低收入成年人医疗费用的金融风险。

附：英文原文

Title: Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

Author: Hiroshi Gotanda, Ashish K Jha, Gerald F Kominski, Yusuke Tsugawa

Issue&Volume: 2020/02/05

Abstract:

Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17).

Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions.

Setting United States.

Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey.

Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons.

Results 37?819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change 28.0% (95% confidence interval 38.4% to 15.8%); adjusted absolute change $122 (￡93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (29.0% (40.5% to 15.3%); $442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change 4.7 (7.9 to 1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions.

Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

DOI: 10.1136/bmj.m40

Source: https://www.bmj.com/content/368/bmj.m40