The Impact of the Affordable Care Act on Trauma Outcomes in At-Risk Groups

Abstract

Objective: Analyze the impact of the Affordable Care Act (ACA) on trauma outcomes at a population level and within at-risk subgroups. Background: Trauma disproportionately affects the uninsured. Compared to the insured, uninsured patients have worse functional outcomes and increased mortality. The goal of the ACA was to increase access to insurance. Methods: An interrupted time series was conducted using data from the National Inpatient Sample database between 2011 and 2016. Data from Alberta, Canada was used as a control group. Mortality, length of stay, and probability of discharge home with or without home health care was examined using monthly time intervals, with January 2014 as the intervention time. Single and multiple group interrupted time series were conducted. Subgroup analyses were conducted using income quartiles and race. Results: After the intervention, there was a monthly reduction in mortality of 0.0148% (P < 0.01) in the American cohort: there was no change in the Canadian cohort. The White subgroup experienced a mortality reduction: the non-White subgroup did not. There was no significant change in length of stay or discharge home rate at a population level. There was a monthly increase in the probability of discharge with home health (0.0247%: P < 0.01); this was present in the lower-income quartiles and both race groups. The White subgroup had a higher rate of utilization of home health pre-ACA, and this discrepancy persisted post-ACA. Conclusions: The ACA is associated with improved mortality and increased use of home health services. Discrepancies amongst racial groups and income quartiles are present.

Impact of Medicaid Expansion on Trauma Patients at Extreme Risk of Mortality: A Time-Series Analysis

“…10 Conversely, a study using NIS data from 2011 to 2016 and a Canadian province as a control found that Medicaid expansion was associated with a greater reduction in trauma in-hospital mortality compared to non-expansion states. 1 The improved survival of severely injured individuals may be attributed to several key factors. Advances in medical technology, such as advanced imaging and damage control surgery, enable more accurate and effective diagnosis and treatment of severe injuries.…”

“…7 In-hospital mortality due to trauma, which is sensitive to the timeliness of care, external factors, and resource availability, serves as a metric for assessing the effectiveness of healthcare interventions, the performance of healthcare facilities, and healthcare policies. 1,2,8 Studies have demonstrated that Medicaid expansion has led to notable improvements in various healthcare aspects, including enhanced access to care, post-discharge rehabilitation services, and hospital financial stability. 4,[9][10][11] Nonetheless, the existing literature on the impact of ACAME on trauma in-hospital mortality presents conflicting findings.…”

“…4,[9][10][11] Nonetheless, the existing literature on the impact of ACAME on trauma in-hospital mortality presents conflicting findings. 1,2 To address this research gap, quasi-experimental modeling, specifically utilizing interrupted time-series analysis (ITSA), was used. Quasi-experimental techniques are well-suited for studying the effects of healthcare policies, as randomized control designs are impractical in this context.…”

“…Additionally, the impact of ACAME on trauma in-hospital mortality remains uncertain owing to conflicting results in existing literature. 1,2 ACAME aims to provide health insurance to low-income and vulnerable populations by expanding Medicaid coverage to those under 65 with incomes up to 138% of the federal poverty level. 3 This expansion generates positive externalities within the healthcare system, as it not only targets the direct beneficiaries but also significantly enhances hospitals' financial stability.…”

“…4,9-11 Nonetheless, the existing literature on the impact of ACAME on trauma in-hospital mortality presents conflicting findings. 1,2…”