背景:平价医疗法案的目标是通过扩大保险来改善健康结果,包括扩大医疗补助。我们系统地回顾了有关平价医疗法案医疗补助扩大与心脏预后相关的现有文献。
方法:与系统评价和荟萃分析指南的首选报告项目一致,我们在PubMed中进行了系统的搜索,Cochrane图书馆,以及使用医疗补助扩大和心脏等关键词的护理和相关健康文献的累积指数,心血管,或心脏,以确定2014年1月至2022年7月发布的评估医疗补助扩大与心脏结局之间关联的标题。
结果:共有30项研究符合纳入和排除标准。其中,14项研究(47%)使用差异研究设计,10项(33%)使用多时间序列设计。评估的扩张后年数的中位数为2(范围,0.5-6),包括的扩展状态的中位数为23(范围,1-33).通常评估的结果包括心脏治疗的保险覆盖和利用(25.0%),发病率/死亡率(19.6%),护理方面的差距(14.3%),和预防保健(41.1%)。医疗补助的扩大通常与保险覆盖面的增加有关,降低急性护理环境之外的总体心脏病发病率/死亡率,心脏合并症的筛查和治疗有所增加。
结论:目前的文献表明,扩大医疗补助通常与增加心脏治疗的保险覆盖率有关。急性护理环境之外的心脏结果改善,以及以心脏为重点的预防和筛查方面的一些改进。结论是有限的,因为扩展和非扩展状态的准实验比较不能解释未测量的状态级混杂因素。
The goal of the Affordable Care Act was to improve health outcomes through expanding insurance, including through Medicaid expansion. We systematically reviewed the available literature on the association of Affordable Care Act Medicaid expansion with cardiac outcomes.
Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed systematic searches in PubMed, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature using the keywords such as Medicaid expansion and cardiac, cardiovascular, or heart to identify titles published from 1/2014 to 7/2022 that evaluated the association between Medicaid expansion and cardiac outcomes.
A total of 30 studies met inclusion and exclusion criteria. Of these, 14 studies (47%) used a difference-in-difference study design and 10 (33%) used a multiple time series design. The median number of postexpansion years evaluated was 2 (range, 0.5-6) and the median number of expansion states included was 23 (range, 1-33). Commonly assessed outcomes included insurance coverage of and utilization of cardiac treatments (25.0%), morbidity/mortality (19.6%), disparities in care (14.3%), and preventive care (41.1%). Medicaid expansion was generally associated with increased insurance coverage, reduction in overall cardiac morbidity/mortality outside of acute care settings, and some increase in screening for and treatment of cardiac comorbidities.
Current literature demonstrates that Medicaid expansion was generally associated with increased insurance coverage of cardiac treatments, improvement in cardiac outcomes outside of acute care settings, and some improvements in cardiac-focused prevention and screening. Conclusions are limited because quasi-experimental comparisons of expansion and nonexpansion states cannot account for unmeasured state-level confounders.