The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector
American Economic Journal: Economic Policy · 2022 · Mark Duggan、Atul Gupta、Emilie Jackson
中文摘要
我们利用《平价医疗法案》实施所引致的65岁医疗保险覆盖断点的变化，考察其对保险覆盖、医院使用和患者健康的影响。随后我们将这些变化与对医院财务状况的影响相联系。我们表明，联邦资助的医疗补助扩展中有相当大的一部分替代了现有由地方资助的安全网项目。尽管存在这一抵消，该扩展仍带来了医院收入的显著增加，并反映为营业盈余的等量增加。我们未检测到患者死亡率的改善，尽管该扩展导致医院和急诊室使用大幅增加。（JEL H51, H75, I12, I13, I18, I38）
Abstract
We exploit changes in the discontinuity in health insurance coverage at age 65 induced by the implementation of the Affordable Care Act to examine effects on coverage, hospital use, and patient health. We then link these changes to effects on hospital finances. We show that a substantial share of the federally funded Medicaid expansion substituted for existing locally funded safety net programs. Despite this offset, the expansion produced a substantial increase in hospital revenue, reflected in an equivalent increase in operating surplus. We do not detect improvements in patient mortality, although the expansion led to substantially greater hospital and emergency room use. (JEL H51, H75, I12, I13, I18, I38)