Medicaid Expansion Affects Rural And Urban Hospitals Differently.
Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the average effect of Medicaid expansion in 2014 on payer mix and profitability for urban and rural hospitals, controlling for secular trends. For both types of hospitals, we found that Medicaid expansion was associated with increases in Medicaid-covered discharges. However, the increases in Medicaid revenue were greater among rural hospitals than urban hospitals, and the decrease in the proportion of costs for uncompensated care were greater among urban hospitals than rural hospitals. This preliminary analysis of the early effects of Medicaid expansion suggests that its financial impacts may be different for hospitals in urban and rural locations.
Brystana G. Kaufman (bkaufman@live.unc.edu) is a doctoral student in the Department of Health Policy and Management and a graduate research assistant with the North Carolina Rural Health Research Program at the Cecil G. Sheps Center for Health Services Research, both at the University of North Carolina at Chapel Hill.
Brystana G
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Kaufman
Kristin L. Reiter is an associate professor in the Department of Health Policy and Management and a research fellow in the North Carolina Rural Health Research Program at the Sheps Center, both at UNC-Chapel Hill.
Kristin L
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Reiter
George H. Pink is the Humana Distinguished Professor in the Department of Health Policy and Management and a senior research fellow in the North Carolina Rural Health Research Program at the Sheps Center, both at UNC-Chapel Hill.
George H
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Pink
George M. Holmes is an associate professor in the Department of Health Policy and Management and director of the North Carolina Rural Health Research Program at the Sheps Center, both at UNC-Chapel Hill.
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Holmes
D003695:Delivery of Health Care / Q000191:economics; D004469:Economics, Hospital / Q000639:trends*; D005260:Female; D006780:Hospitals, Rural / Q000191:economics*; D006786:Hospitals, Urban / Q000191:economics*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D017664:Uncompensated Care / Q000191:economics*; D014481:United States
Affordable Care Act; Hospital Profitability; Medicaid Expansion; Rural Health Care; Uncompensated Care