The Affordable Care Act is expected to profoundly affect inpatient hospital utilization, both as a result of expansions in insurance coverage as well as payment and delivery system reforms. The objective of this study is to examine changes in inpatient utilization between 2010 and 2013 in California, following a Medicaid expansion and implementation of the Delivery System Reform Incentive Payment program. Findings show that between 2010 and 2013: (a) the overall number of inpatient admissions increased, mainly because an increase in Medicaid admissions exceeded the decrease in uninsured admissions; (b) the number of preventable admissions did not change; (c) preventable admissions decreased at safety net hospitals that received Delivery System Reform Incentive Payment funds relative to other safety net hospitals. The results suggest that delivery system reforms may help offset the upward pressures on utilization and costs due to coverage expansions.
BachrachD.BoozangP.LipsonM. (2015). The impact of Medicaid expansion on uncompensated care costs: Early results and policy implications for states (Robert Wood Johnson Foundation). Princeton, NJ: State Health Reform Assistance Network.
BazzoliG. J.ClementJ. P. (2014). The experiences of Massachusetts hospitals as statewide health insurance reform was implemented. Journal of Health Care for the Poor and Underserved, 25, 63-78.
8.
BazzoliG.KangR.Hasnian-WyniaR.LindroothR. C. (2005). An update on safety-net hospitals: Coping with the late 1990s and early 2000s. Health Affairs, 24, 1047-1056.
9.
California Association of Public Hospitals and Health Systems. (2015). California’s Delivery System Reform Incentive Program 2010-2015: Successes to build on. Retrieved from http://caph.org/dsripsuccess/
DeLeireT.DagueL.LeiningerL.VoskullK.FriedsamD. (2013). Wisconsin experience indicates that expanding public insurance to low-income childless adults has health care impacts. Health Affairs, 32, 1037-1045.
15.
GolbersteinE.GonzalesG.SommersB. D. (2015). California’s early ACA expansion increased coverage and reduced out-of-pocket spending for the state’s low-income population. Health Affairs, 34, 1688-1694.
16.
MohanA.GrantJ.BataldenM.McCormickD. (2013). The health of safety net hospitals following Massachusetts health care reform: Changes in volume, revenue, costs, and operating margins from 2006 to 2009. International Journal of Health Services, 43, 321-335.
17.
NikpayS.BuchmuellerT.LevyH .G. (2016). Affordable Care Act Medicaid expansion reduced uninsured hospital stays in 2014. Health Affairs, 35, 106-110.
