The impact of Medicaid expansion and travel distance on access to transplantation
中文摘要
大多数移植中心要求候选人在加入逝者供体器官等待名单之前必须拥有保险。《平价医疗法案》(Affordable Care Act, ACA)通过后,许多原本没有保险的美国人获得了更好的Medicaid准入。我考察了保险可及性提高的效应,发现Medicaid扩展使Medicaid参保者的等待名单登记显著增加39%,使患者获得的逝者供体移植增加44%,但登记的增加幅度对于居住地距移植中心较近的候选人更大。此外,我表明这些登记中的大多数若无此变化本应拥有私人保险,但提示性证据表明,这一结果更宜归因于其他ACA改革改善了获得补贴型私人保险的机会,而非ACA实施前已有私人保险的候选人在扩展后转向Medicaid。这表明,尽管ACA改善了移植系统的可及性,但居住地远离移植中心的候选人的可及性仍然受限。
Abstract
Most transplant centers require candidates be insured before they can join the waitlist for a deceased donor organ. After the Affordable Care Act, many uninsured Americans gained improved access to Medicaid. I examine the effect of this increase in access to insurance and find that Medicaid expansions significantly increase Medicaid-insured waitlist registrations by 39% and deceased donor transplants received by 44%, but the increase in registrations is larger for candidates who live closer to a transplant center. Additionally I show that most of these registrations would have been privately insured otherwise but provide suggestive evidence that this is better explained by improved access to subsidized private coverage due to other ACA reforms than from candidates with private coverage before the ACA switching to Medicaid coverage after expansion. This suggests that although the ACA improved access to the transplantation system, access is still limited for candidates who live far from centers.