Comparing health care use and costs among new Medicaid enrollees before and during the COVID-19 pandemic

Abstract

Background and Objective To characterize health care use and costs among new Medicaid enrollees before and during the COVID pandemic. Results can help Medicaid non-expansion states understand health care use and costs of new enrollees in a period of enrollment growth. Research Design Retrospective cross-sectional analysis of North Carolina Medicaid claims data (January 1, 2018 - August 31, 2020). We used modified Poisson and ordinary least squares regression analysis to estimate health care use and costs as a function of personal characteristics and enrollment during COVID. Using data on existing enrollees before and during COVID, we projected the extent to which changes in outcomes among new enrollees during COVID were pandemic-related. Subjects 340,782 new enrollees pre-COVID (January 2018 – December 2019) and 56,428 new enrollees during COVID (March 2020 – June 2020). Measures We observed new enrollees for 60-days after enrollment to identify emergency department (ED) visits, nonemergent ED visits, primary care visits, potentially-avoidable hospitalizations, dental visits, and health care costs. Results New Medicaid enrollees during COVID were less likely to have an ED visit (-46 % [95 % CI: -48 %, -43 %]), nonemergent ED visit (-52 % [95 % CI: -56 %, -48 %]), potentially-avoidable hospitalization (-52 % [95 % CI: -60 %, -43 %]), primary care visit (-34 % [95 % CI: -36 %, -33 %]), or dental visit (-36 % [95 % CI: -41 %, -30 %]). They were also less likely to incur any health care costs (-29 % [95 % CI: -30 %, -28 %]), and their total costs were 8 % lower [95 % CI: -12 %, -4 %]. Depending on the outcome, COVID explained between 34 % and 100 % of these reductions. Conclusions New Medicaid enrollees during COVID used significantly less care than new enrollees pre-COVID. Most of the reduction stems from pandemic-related changes in supply and demand, but the profile of new enrollees before versus during COVID also differed.

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review

“…In total, n = 9 articles were included in this review. Among the included studies, five studies [ 23 , 24 , 25 , 26 , 27 ] were conducted in the United States, two [ 28 , 29 ] in Japan, one in Taiwan [ 30 ], and one in Canada [ 31 ]. The most recent studies were published in 2021–2022 [ 23 , 26 , 27 , 31 ], and two more were published in the years 2017 and 2018 [ 28 , 29 ], while the remaining three were published before 2013 [ 24 , 25 , 30 ].…”

“…Among the included studies, five studies [ 23 , 24 , 25 , 26 , 27 ] were conducted in the United States, two [ 28 , 29 ] in Japan, one in Taiwan [ 30 ], and one in Canada [ 31 ]. The most recent studies were published in 2021–2022 [ 23 , 26 , 27 , 31 ], and two more were published in the years 2017 and 2018 [ 28 , 29 ], while the remaining three were published before 2013 [ 24 , 25 , 30 ]. Five of the included studies [ 23 , 26 , 27 , 30 , 31 ] refer to slow-onset disasters (i.e., epidemics), while the other four [ 24 , 25 , 28 , 29 ] refer to sudden-onset disasters (i.e., earthquake, chemical spill).…”

“…The most recent studies were published in 2021–2022 [ 23 , 26 , 27 , 31 ], and two more were published in the years 2017 and 2018 [ 28 , 29 ], while the remaining three were published before 2013 [ 24 , 25 , 30 ]. Five of the included studies [ 23 , 26 , 27 , 30 , 31 ] refer to slow-onset disasters (i.e., epidemics), while the other four [ 24 , 25 , 28 , 29 ] refer to sudden-onset disasters (i.e., earthquake, chemical spill). Two studies [ 25 , 30 ] used interrupted time series analysis, two [ 23 , 24 ] were conducted as a pre-/post-test study, three had a cross-sectional design [ 26 , 27 , 28 ], and two had a retrospective cohort or population-based design [ 29 , 31 ].…”

“…Five of the included studies [ 23 , 26 , 27 , 30 , 31 ] refer to slow-onset disasters (i.e., epidemics), while the other four [ 24 , 25 , 28 , 29 ] refer to sudden-onset disasters (i.e., earthquake, chemical spill). Two studies [ 25 , 30 ] used interrupted time series analysis, two [ 23 , 24 ] were conducted as a pre-/post-test study, three had a cross-sectional design [ 26 , 27 , 28 ], and two had a retrospective cohort or population-based design [ 29 , 31 ]. All studies were aimed at assessing the impact of disasters on ACSC hospitalization rates, except for Wright et al (2021), which compared health care use and costs of individuals enrolled in Medicaid before the COVID-19 pandemic vs. those enrolled in Medicaid during the first COVID-19 wave.…”

“…One study [ 31 ] used Canada’s National Ambulatory Care Reporting System to obtain population-based data on ACSC hospitalizations. The last study [ 27 ] used North Carolina Medicaid claims data and examined different patterns of Medicaid enrollees.…”