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Community Health Center Use After Oregon's Randomized Medicaid Experiment.

Authors
  • DeVoe, Jennifer E1
  • Marino, Miguel2
  • Gold, Rachel3
  • Hoopes, Megan J4
  • Cowburn, Stuart4
  • O'Malley, Jean P5
  • Heintzman, John6
  • Gallia, Charles7
  • McConnell, K John8
  • Nelson, Christine A4
  • Huguet, Nathalie6
  • Bailey, Steffani R9
  • 1 Oregon Health & Science University, Department of Family Medicine, Portland, Oregon OCHIN, Inc, Portland, Oregon.
  • 2 Oregon Health & Science University, Department of Family Medicine, Portland, Oregon Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon.
  • 3 OCHIN, Inc, Portland, Oregon Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
  • 4 OCHIN, Inc, Portland, Oregon.
  • 5 Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon.
  • 6 Oregon Health & Science University, Department of Family Medicine, Portland, Oregon.
  • 7 Office of Health Analytics, Oregon Health Authority, Portland, Oregon.
  • 8 Center for Health System Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
  • 9 Oregon Health & Science University, Department of Family Medicine, Portland, Oregon [email protected]
Type
Published Article
Journal
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Publication Date
Jan 01, 2015
Volume
13
Issue
4
Pages
312–320
Identifiers
DOI: 10.1370/afm.1812
PMID: 26195674
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment"). We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings. © 2015 Annals of Family Medicine, Inc.

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