未经评估:最近的健康政策变化优先为更多美国人提供保险,通常通过医疗补助扩张(ME)。可以通过比较在有和没有ME的状态下进行心脏移植的Medicaid受益人的体积来衡量ME与扩大心脏移植途径有关的有效性。我们的目标是确定ME是否增加了心脏移植的机会。
UNASSIGNED:器官采购和移植网络数据库用于美国移植数据。差异差异(DID),一种估计因果关系的计量经济学方法,在有ME的状态和没有ME的边界状态之间执行,以尽量减少地理变异性。对于具有多个边界非扩展状态的状态,对DiD值进行平均。非配对双尾t检验,Mann-WhitneyU测试,单向方差分析,和泊松回归,在适当的情况下,比较保险队列,性别,和种族。
UNASSIGNED:尽管2000年公共保险患者仅占心脏移植体积的36.7%,但在2020年占心脏移植体积的53.4%(P=0.229);公共和私人移植体积之间没有显着差异(P=0.583),但存在于公共保险形式中(P<.001)。ME每年每州多移植1.028次,总共增加了113.9例移植。移植体积在ME状态和非ME状态之间有显著差异(31.4%vs58.4%;P<.001)。男性男性心脏移植累计增加106例(DiD=0.956),与女性累计移植10.23例相比(DiD=0.090);这种性别DiD差异不显著(P=.749)。在ME和非ME状态下,男性和女性的心脏移植体积显着不同(P<.001)。自2014年以来,ME的白人移植率增加了25.67例(DiD=0.079),黑人的移植数量增加了55.78例(DiD=0.510),西班牙裔的移植数量减少2.85(DiD=-0.038),亚洲人的移植数量增加了37.33(DiD=0.316),美洲原住民的移植数量减少14.5(DiD=-0.105),17.38太平洋岛民的移植减少(DiD=-0.131),多种族个体移植12.85例(DiD=0.134);这些种族DiD差异不显着(P=.957)。
未经评估:心脏移植量不再偏向于有私人保险的患者,建议扩大公共保险增加心脏移植的机会,根据器官采购和移植网络数据库。通过一个全国性的DID模型,我增加了医疗补助受益人的心脏移植量,主要是通过男性,黑色,亚洲患者。这些好处在不同的人口统计学特征上是不同的,并不能使所有群体受益,建议如果政策目标是公平地增加性别和种族的数量,则应对ME进行改造。
UNASSIGNED: Recent health policy changes have prioritized providing insurance for more Americans, often through Medicaid expansion (ME). The effectiveness of ME as it relates to expanding access to heart transplantation can be gauged by comparing the volume of Medicaid beneficiaries undergoing heart transplantation volume in states with and without ME. Our objective is to determine whether or not ME increased access to heart transplantation.
UNASSIGNED: The Organ Procurement and Transplantation Network database was used for US transplant data. Difference-in-differences (DiD), an econometric method to estimate causality, was performed between states with ME and bordering states without ME, to minimize geographic variability. For states with multiple bordering nonexpanded states, DiD values were averaged. Unpaired 2-tailed t tests, Mann-Whitney U test, 1-way-analysis of variance, and Poisson regressions, where appropriate, compared insurance cohorts, sexes, and ethnicities.
UNASSIGNED: Although publicly insured patients comprised only 36.7% of heart transplant volume in 2000, they comprised 53.4% of heart transplant volume in 2020 (P = .229); significant differences did not exist between public and private transplant volume (P = .583), but exist among forms of public insurance (P < .001). ME yielded 1.028 more transplants per state per year, and a total of 113.9 more transplants. Transplant volume was significantly different between ME states and non-ME states (31.4% vs 58.4%; P < .001). ME yielded 106 more heart transplants in men cumulatively (DiD = 0.956), compared with 10.23 more transplants in women cumulatively (DiD = 0.090); this sex DiD difference was not significant (P = .749). Heart transplant volumes were significantly different for both men and women across ME and non-ME states (P < .001 for both). Since 2014, ME yielded 25.67 more transplants in Whites (DiD = 0.079), 55.78 more transplants in Blacks (DiD = 0.510), 2.85 fewer transplants in Hispanics (DiD = -0.038), 37.33 more transplants in Asians (DiD = 0.316), 14.5 fewer transplants in Native Americans (DiD = -0.105), 17.38 fewer transplants in Pacific Islanders (DiD = -0.131), and 12.85 more transplants in multiracial individuals (DiD = 0.134); these ethnic DiD differences were not significant (P = .957).
UNASSIGNED: Heart transplant volume is no longer skewed toward patients with private insurance, suggesting expanding public insurance increased access to heart transplantation, according to the Organ Procurement and Transplantation Network database. Through a national DiD model, ME increased heart transplant volume for Medicaid beneficiaries, largely through male, Black, and Asian patients. These benefits were dissimilar across demographic characteristics and do not benefit all groups, suggesting ME should be remodeled if the policy aim is to equitably increase volume across sexes and ethnicities.