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The Effect of Large-scale Health Coverage Expansions in Wealthy Nations on Society-Wide Healthcare Utilization

  • Adam GaffneyEmail author
  • Steffie Woolhandler
  • David Himmelstein
Review

Abstract

Most analysts project that a reform like Medicare-for-All that lowers financial barriers to care would cause a surge in the utilization of services, raising costs despite stable or even reduced prices. However, the finite supply of physicians and hospital beds could constrain such utilization increases. We reviewed the effects of 13 universal coverage expansions in capitalist nations on physician and hospital utilization, beginning with New Zealand’s 1938 Social Security Act up through the 2010 Affordable Care Act in the USA. Almost all coverage expansions had either a small (i.e., < 10%) or no effect on society-wide utilization. However, coverage expansions often redistributed care—increasing use among newly covered groups while producing small, offsetting reductions among those already covered. We conclude that in wealthy nations, large-scale coverage expansions need not cause overall utilization to surge if provider supply is controlled. However, such reforms could redirect care towards patients who most need it.

KEY WORDS

healthcare reform healthcare utilization 

Notes

Acknowledgments

We thank the following individuals for their assistance and guidance:

New Zealand: Ian Powell and Lyndon Keene.

UK: Martin Gorsky; John Mohan; Martin Powell.

Sweden: Finn Diderichsen.

Canada: Greg Marchildon

Finland: Lauri Vuorenkoski

Belgium: Jean-Pierre Unger; Pol De Vos.

Australia: Stephen Duckett. Of note, Dr. Duckett provided the table and citation for reference 128.

Portugal: Pedro Pita Barros.

Greece: Alexis Benos; Elias Kondilis; Charalampos Economou. Of note, Elias Kondilis provided the data displayed in E-Figure 2.

Spain: Vicente Navarro

Norway: Andy Oxman; Ingrid Sperre Saunes.

Taiwan: Tsung-Mei Cheng

Compliance with Ethical Standards

Conflict of Interest

The authors serve as leaders of physicians for a National Health Program (PNHP), a non-profit organization that favors coverage expansion through a single-payer program. None of them receives any compensation from that group; some of Dr. Gaffney’s travel on behalf of the organization is reimbursed by it. The authors report no conflicts of interest with any commercial entities.

Supplementary material

11606_2019_5529_MOESM1_ESM.docx (97 kb)
ESM 1 (DOCX 96 kb)

References

  1. 1.
    McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Use of health services by previously uninsured Medicare beneficiaries. N Engl J Med. 2007;357(2):143–153.  https://doi.org/10.1056/NEJMsa067712 CrossRefPubMedGoogle Scholar
  2. 2.
    Zhou RA, Baicker K, Taubman S, Finkelstein AN. The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less. Health Aff (Millwood). 2017;36(12):2115–2122.  https://doi.org/10.1377/hlthaff.2017.0218 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Card D, Dobkin C, Maestas N. The impact of nearly universal insurance coverage on health care utilization: evidence from Medicare. Am Econ Rev. 2008;98(5):2242–2258.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Lichtenberg FR. The Effects of Medicare on Health Care Utilization and Outcomes. (Garber AM, ed.). Cambridge, Mass.: National Bureau of Economic Research; MIT Press; 1998.Google Scholar
  5. 5.
    Buchmueller TC, Grumbach K, Kronick R, Kahn JG. The effect of health insurance on medical care utilization and implications for insurance expansion: a review of the literature. Med Care Res Rev MCRR. 2005;62(1):3–30.  https://doi.org/10.1177/1077558704271718 CrossRefPubMedGoogle Scholar
  6. 6.
    Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987;77(3):251–277.PubMedGoogle Scholar
  7. 7.
    Finkelstein A, Taubman S, Wright B, et al. The Oregon health insurance experiment: evidence from the first year. Q J Econ. 2012;127(3):1057–1106.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Newhouse JP, Manning WG, Morris CN, et al. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981;305(25):1501–1507.  https://doi.org/10.1056/NEJM198112173052504 CrossRefPubMedGoogle Scholar
  9. 9.
    Congressional Budget Office. Single-Payer and All-Payer Health Insurance Systems Using Medicare’s Payment Rates. https://www.cbo.gov/publication/16595. Published 1993. Accessed November 25, 2018.
  10. 10.
    Holahan J, Clemans-Cope L, Buettgens M, Favreault M, Blumberg LJ, Ndwandwe S. The Sanders Single-Payer Health Care Plan. Urban Institute. 2016. https://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending. Accessed July 19, 2018.
  11. 11.
    Liu J, Eibner C. National Health Spending Estimates Under Medicare for All. Santa Monica, CA: RAND Corporation; 2019. https://www.rand.org/pubs/research_reports/RR3106.html.  Accessed April 10, 2019.
  12. 12.
    Blahous C. The Costs of a National Single-Payer Healthcare System. The Mercatus Center. https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf. Accessed July 30, 2018.
  13. 13.
    Pollin R, Heintz J, Arno P, Wicks-Lim J, Ash M. Economic Analysis of Medicare for All. Political Economy Research Institute: University of Massachusetts Amherst. https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all. Published 2018. Accessed December 5, 2018.
  14. 14.
    Gaffney A, McCormick D, Bor D, Woolhandler S, Himmelstein D. Coverage Expansions and Utilization of Physician Care: Evidence From the 2014 Affordable Care Act and 1966 Medicare/Medicaid Expansions. Am J Public Health. October 2019:e1-e8.  https://doi.org/10.2105/AJPH.2019.305330.PubMedCrossRefGoogle Scholar
  15. 15.
    Gaffney A, McCormick D, Bor DH, Goldman A, Woolhandler S, Himmelstein DU. The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States. Ann Intern Med. July 2019.  https://doi.org/10.7326/M18-2806 PubMedCrossRefGoogle Scholar
  16. 16.
    Roemer MI. National Health Systems of the World: Volume I: Countries. New York: Oxford University Press; 1991.Google Scholar
  17. 17.
    Carlyon J.New Zealand Friendly Societies, 1842-1941 [Dissertation]. Auckland University; 2001. https://researchspace.auckland.ac.nz/handle/2292/1033. Accessed November 11, 2018.
  18. 18.
    MacLean H, McHenry DE. Medical Services in New Zealand. Milbank Mem Fund Q. 1948;26(2):148.  https://doi.org/10.2307/3348021 CrossRefPubMedGoogle Scholar
  19. 19.
    Robb D. The New Zealand Health Scheme: A Review contributed to this Journal at the Editor’s request. Postgrad Med J. 1950;26(295):277–282.  https://doi.org/10.1136/pgmj.26.295.277 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Emery GM. New Zealand Medical Care. Med Care. 1966;4(3):159.CrossRefGoogle Scholar
  21. 21.
    Dixon CW. Changes in Hospitals and General Practice under Social Security in New Zealand. Int J Health Serv. 1971;1(4):390–397.  https://doi.org/10.2190/TKKL-85UW-QVKA-8PTR CrossRefPubMedGoogle Scholar
  22. 22.
    The New Zealand Official Year-Books (multiple years: 1937 - 1945). http://archive.stats.govt.nz/browse_for_stats/snapshots-of-nz/digital-yearbook-collection.aspx. Accessed January 12, 2019.
  23. 23.
    Hollingsworth JR. Inequality in Levels of Health in England and Wales, 1891-1971. J Health Soc Behav. 1981;22(3):268–283.  https://doi.org/10.2307/2136521 CrossRefPubMedGoogle Scholar
  24. 24.
    Titmuss RM. Essays on “The Welfare State.” 3rd ed. / introduction by Brian Abel-Smith. London : George Allen & Unwin; 1993.Google Scholar
  25. 25.
    Eckstein H.The English Health Service: It Origins, Structure, and Achievements. Cambridge,: Harvard University Press; 1958.Google Scholar
  26. 26.
    Logan WPD, Brooke EM. The Survey of Sickness, 1943 to 1952. London: HM Stationery Office; 1957.Google Scholar
  27. 27.
    Stewart WH, Enterline PE. Effects of the National Health Service on physician utilization and health in England and Wales. N Engl J Med. 1961;265(24):1187–1194.  https://doi.org/10.1056/NEJM196112142652405 CrossRefPubMedGoogle Scholar
  28. 28.
    Logan WPD. Illness, incapacity, and medical attention among adults, 1947-49. Lancet. 1950;1(6608):773–776.PubMedCrossRefGoogle Scholar
  29. 29.
    Ito H. Health insurance policy development in Denmark and Sweden 1860--1950. Soc Sci Med. 1979;13C(3):143–160.CrossRefGoogle Scholar
  30. 30.
    Seldowitz E, Brewster AW. Sweden’s health and cash sickness insurance program. Public Health Rep. 1964;79(9):815–822.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Werkö L. Swedish Medical Care in Transition. N Engl J Med. 1971;284(7):360–366.  https://doi.org/10.1056/NEJM197102182840705 CrossRefPubMedGoogle Scholar
  32. 32.
    Shenkin BN. Politics and Medical Care in Sweden: The Seven Crowns Reform. N Engl J Med. 1973;288(11):555–559.  https://doi.org/10.1056/NEJM197303152881105 CrossRefPubMedGoogle Scholar
  33. 33.
  34. 34.
    Collings FD. National hospital insurance in Canada. Public Health Rep Wash DC 1896. 1959;74:1049–1058.Google Scholar
  35. 35.
    OECD Health Statistics 2018. Social protection: Total public and primary private health insurance. www.oecd.org/els/health-systems/health-data.htm.
  36. 36.
    Gelber SM. The first decade: ten years of hospital insurance. Med Serv J Can. 1967;23(9):1134–1143.PubMedGoogle Scholar
  37. 37.
    Reed LS. Hospital utilization under the Canadian national hospital insurance program. Am J Public Health Nations Health. 1965;55(3):435–445.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Vayda E. Universal hospital and medical care insurance in Canada: utilization and cost performance. J Public Health Policy. 1981;2(1):75–79.  https://doi.org/10.2307/3342101 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Taylor MG. Hospital utilization and costs under compulsory prepaid coverage. Can Hosp. 1950;27(2):38.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Reed LS, Carr W. Utilization and cost of general hospital care: Canada and the United States, 1948–66. Soc Secur Bull. 1968:9.Google Scholar
  41. 41.
    Andersen R, Hull JT. Hospital utilization and cost trends in Canada and the United States. Health Serv Res. 1969;4(3):198–222.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Government of Canada, Public Services and Procurement Canada. Illness and health care in Canada : Canadian Sickness Survey, 1950-51 / prepared jointly by the Department of National Health and Welfare and the Dominion Bureau of Statistics.: CS82-518/1960E-PDF - Government of Canada Publications - Canada.ca. http://publications.gc.ca/site/eng/9.844511/publication.html. Accessed November 19, 2018.
  43. 43.
    Manga P, Broyles RW, Angus DE. The Determinants of Hospital Utilization under a Universal Public Insurance Program in Canada. Med Care. 1987;25(7):658–670.PubMedCrossRefGoogle Scholar
  44. 44.
    Preker A. Financing Universal Access to Healthcare: A Comparative Review of Landmark Legislative Health Reforms in the OECD. New Jersey: World Scientific; 2018.CrossRefGoogle Scholar
  45. 45.
    Pesonen N. Sickness insurance in Finland. Can J Public Health Rev Can Santee Publique. 1965;56(6):263–264.Google Scholar
  46. 46.
    Gosset JR. Medical demography and medical economics in Finland. World Med J. 1964;11:183–184.PubMedGoogle Scholar
  47. 47.
    Purola T, Kalimo E, Nyman K, Sievers K. National Health Insurance in Finland: Its Impact and Evaluation. Int J Health Serv. 1973;3(1):69–80.  https://doi.org/10.2190/LJYA-KTWW-6537-4B82 CrossRefPubMedGoogle Scholar
  48. 48.
    Health Systems in Transition (HiT) profile of Finland. https://www.hspm.org/countries/finland21082013/livinghit.aspx?Section = 7.1%20Analysis%20of%20recent%20reforms&Type = Section. Accessed November 14, 2018.
  49. 49.
    Nyman K, Kalimo E. National sickness insurance and the use of physicians’ services in Finland. Soc Sci Med 1967. 1973;7(7):541–553.  https://doi.org/10.1016/0037-7856(73)90064-4 CrossRefGoogle Scholar
  50. 50.
    Mott FD. What More Prepayment for Medical Services Will Do to Hospitals. Med Care. 1967;5(5):325–333.CrossRefGoogle Scholar
  51. 51.
    Swanson AL. Some effects of “Medicare” on hospitals in Saskatchewan. Can Hosp. 1965;42(12):42–45.PubMedGoogle Scholar
  52. 52.
    Greenhill S.AlbertaHealth Care Study: Health Care Utilization Patterns of Albertans, 1968 and 1970. Final Report. Edmonton: Department of Community Medicine, University of Alberta; 1972.Google Scholar
  53. 53.
    Enterline PE, Salter V, McDonald AD, McDonald JC. The distribution of medical services before and after free medical care — the Quebec experience. N Engl J Med. 1973;289(22):1174–1178.  https://doi.org/10.1056/NEJM197311292892206 CrossRefPubMedGoogle Scholar
  54. 54.
    McDonald AD, McDonald JC, Salter V, Enterline PE. Effects of Quebec Medicare on physician consultation for selected symptoms. N Engl J Med. 1974;291(13):649–652.  https://doi.org/10.1056/NEJM197409262911304 CrossRefPubMedGoogle Scholar
  55. 55.
    Siemiatycki J, Richardson L, Pless IB. Equality in medical care under national health insurance in Montreal. N Engl J Med. 1980;303(1):10–15.  https://doi.org/10.1056/NEJM198007033030103 CrossRefPubMedGoogle Scholar
  56. 56.
    Broyles RW, Manga P, Binder DA, Angus DE, Charette A. The use of physician services under a national health insurance scheme. An examination of the Canada Health Survey. Med Care. 1983;21(11):1037–1054.PubMedCrossRefGoogle Scholar
  57. 57.
    Council of Economic Advisers. Methodological Appendix: Methods Used to Construct a Consistent Historical Time Series of Health Insurance Coverage.; 2014. https://obamawhitehouse.archives.gov/sites/default/files/docs/longtermhealthinsuranceseriesmethodologyfinal.pdf. Accessed September 9, 2018.
  58. 58.
    Lonni LJ, Bradley IE. Medicare; a statistical study on utilization. Hosp Manage. 1966;101(5):29–33.PubMedGoogle Scholar
  59. 59.
    Finkelstein A. The aggregate effects of health insurance: evidence from the introduction of Medicare. Q J Econ. 2007;122(1):1–37.  https://doi.org/10.1162/qjec.122.1.1 CrossRefGoogle Scholar
  60. 60.
    Lubitz J, Deacon R. The Rise in the Incidence of Hospitalizations for the Aged, 1967 to 1979. Health Care Financ Rev. 1982;3(3):21–40.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Ferguson C, Lee ML, Wallace R. Effects of Medicare on hospital use: a disease-specific study. Med Care. 1976;14(7):547–589.PubMedGoogle Scholar
  62. 62.
    Pettengill JH. Trends in hospital use by the aged. Soc Secur Bull. 1972;35:3–15.Google Scholar
  63. 63.
    Ament RP. Medicare boosts bed usage by elderly. Mod Hosp. 1967;108(2):81–82.PubMedGoogle Scholar
  64. 64.
    Lowenstein R. Early effects of Medicare on the health care of the aged. Soc Sec Bull. 1971;34:3.Google Scholar
  65. 65.
    Palmore E, Jeffers FC. Health Care in a Longitudinal Panel Before and After Medicare. J Gerontol. 1971;26(4):532–536.  https://doi.org/10.1093/geronj/26.4.532 CrossRefPubMedGoogle Scholar
  66. 66.
    National Disease and Therapeutic Index. The Current Impact of Medicare on U.S. Private Medical Practice January 1967. Ambler, Pennsylvania: Lea Associated, Inc.; 1967.Google Scholar
  67. 67.
  68. 68.
    Healy J, Lokuge B. Australia: Health system review. Eur Obs Health Syst Policies. 2006;8(5):178.Google Scholar
  69. 69.
    Moorin R, Brameld KJ, Holman CDJ. Health care financing and public responses: use of private insurance in Western Australia during 1980-2001. Aust Health Rev Publ Aust Hosp Assoc. 2006;30(1):73–82.CrossRefGoogle Scholar
  70. 70.
    Scotton RB. Medibank: from conception to delivery and beyond. Med J Aust. 2000;173(1):9–11.PubMedCrossRefGoogle Scholar
  71. 71.
    Has Medibank affected public hospitals? Aust Hosp. 1978;(18):8–9.Google Scholar
  72. 72.
    Scotton RB. Medibank 1976. Aust Econ Rev. 1977;10(1):23–35.  https://doi.org/10.1111/j.1467-8462.1977.tb00703.x CrossRefGoogle Scholar
  73. 73.
    OECD Health Statistics 2018. Health Care Utilisation. https://stats.oecd.org/Index.aspx?DataSetCode = HEALTH_PROC#.
  74. 74.
    Richardson JRG, Philips TJ. Report of a Survey of Sydney Medical Practitioners before and after Medibank. Macquaraie University, School of Economic & Financial Studies; 1977.Google Scholar
  75. 75.
    de Almeida Simoes J, Augusto GF, Fronteira I, Hernandez-Quevedo C. Portugal: Health System Review. Health Syst Transit. 2017;19(2):1–184.Google Scholar
  76. 76.
    Dixon A, Mossialos E. Has the Portuguese NHS Achieved its Objectives of Equity and Efficiency? Int Soc Secur Rev. 2000;53(4):49–78.  https://doi.org/10.1111/1468-246X.00105 CrossRefGoogle Scholar
  77. 77.
    do Rosário Giraldes M. The equity and efficiency principle in the financing system of the NHS in Portugal. Health Policy. 1990;14(1):13–28.  https://doi.org/10.1016/0168-8510(90)90295-O CrossRefGoogle Scholar
  78. 78.
    Oliveira MD, Pinto CG. Health care reform in Portugal: an evaluation of the NHS experience. Health Econ. 2005;14(Suppl 1):S203–220.  https://doi.org/10.1002/hec.1037 CrossRefPubMedGoogle Scholar
  79. 79.
    Tsalikis G. Evaluation of the socialist health policy in Greece. Int J Health Serv Plan Adm Eval. 1988;18(4):543–561.  https://doi.org/10.2190/M3TE-L30H-TYHW-HKQH CrossRefGoogle Scholar
  80. 80.
    Economou C. Greece: Health system review. Health Syst Transit. 2010;12(7):1–177, xv-xvi.PubMedGoogle Scholar
  81. 81.
    Apostolides AD. The Health Care System in Greece Since 1970: An Assessment. Int J Health Care Qual Assur Bradf. 1992;5(5):4.  https://doi.org/10.1108/09526869210020154 CrossRefGoogle Scholar
  82. 82.
    Kyriopoulos JE, Tsalikis G. Public and private imperatives of Greek health policies. Health Policy Amst Neth. 1993;26(2):105–117.CrossRefGoogle Scholar
  83. 83.
    Kondilis E.Private Health Sector in Greece: Development Characteristics, Quality Evaluation, Recent Trends and Prospectives. Thessaloniki: Aristotle University of Thessaloniki; 2009. http://thesis.ekt.gr/thesisBookReader/id/22539#page/1/mode/2up.Google Scholar
  84. 84.
    Blendon RJ, Donelan K, Jovell AJ, Pellisé L, Lombardia EC. Spain’s Citizens Assess Their Health Care System. Health Aff (Millwood). 1991;10(3):216–228.  https://doi.org/10.1377/hlthaff.10.3.216 CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Rodríguez E, Gallo de Puelles P, Jovell AJ. The Spanish health care system: lessons for newly industrialized countries. Health Policy Plan. 1999;14(2):164–173.PubMedCrossRefGoogle Scholar
  86. 86.
    García Gómez P, López Nicolás A. Public and Private Health Insurance and the Utilisation of Health Care in Spain. In: Equity. Vol 15. Research on Economic Inequality. Emerald Group Publishing Limited; 2007:169–195.  https://doi.org/10.1016/S1049-2585(07)15008-0 Google Scholar
  87. 87.
    Cheng T-M. Taiwan’s New National Health Insurance Program: Genesis And Experience So Far. Health Aff Millwood. 2003;22(3):61–76.  https://doi.org/10.1377/hlthaff.22.3.61 CrossRefPubMedGoogle Scholar
  88. 88.
    Lu J-FR, Hsiao WC. Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan. Health Aff Millwood. 2003;22(3):77–88.  https://doi.org/10.1377/hlthaff.22.3.77 PubMedCrossRefGoogle Scholar
  89. 89.
    Chen C-S, Liu T-C, Chen L-M. National Health Insurance and the antenatal care use: a case in Taiwan. Health Policy Amst Neth. 2003;64(1):99–112.PubMedCrossRefGoogle Scholar
  90. 90.
    Chen C-S, Liu T-C, Lin H-C, Tian W-H. The effect of Taiwan’s National Health Insurance on infants’ preventive care use and inpatient care use. Health Policy Amst Neth. 2007;80(3):432–443.  https://doi.org/10.1016/j.healthpol.2006.04.003 CrossRefGoogle Scholar
  91. 91.
    Shou-Hsia C, Tung-Liang C. The effect of universal health insurance on health care utilization in Taiwan: results from a natural experiment. JAMA. 1997;278(2):89–93.  https://doi.org/10.1001/jama.1997.03550020017009 CrossRefGoogle Scholar
  92. 92.
    Chen L, Yip W, Chang M-C, et al. The effects of Taiwan’s National Health Insurance on access and health status of the elderly. Health Econ. 2007;16(3):223–242.  https://doi.org/10.1002/hec.1160 CrossRefPubMedGoogle Scholar
  93. 93.
    Liao P-A, Chang H-H, Yang F-A. Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in Taiwan. J Rural Health Off J Am Rural Health Assoc Natl Rural Health Care Assoc. 2012;28(1):84–91.  https://doi.org/10.1111/j.1748-0361.2011.00363.x CrossRefGoogle Scholar
  94. 94.
    Chen LM, Wen SW, Li CY. The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan. Matern Child Health J. 2001;5(1):35–42.PubMedCrossRefGoogle Scholar
  95. 95.
    Liu T-C, Chen C-S, Chen L-M. The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan. Health Policy Plan. 2002;17(4):384–392.PubMedCrossRefGoogle Scholar
  96. 96.
    Liao P-A, Chang H-H, Yang F-A. Does the Universal Health Insurance Program Affect Urban-Rural Differences in Health Service Utilization Among the Elderly? Evidence From a Longitudinal Study in Taiwan. J Rural Health. 2012;28(1):84–91.  https://doi.org/10.1111/j.1748-0361.2011.00363.x CrossRefPubMedGoogle Scholar
  97. 97.
    Cohen RA, Zammitti EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017. National center for health statistics; 2018. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf.
  98. 98.
    Meinhofer A, Witman AE. The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion. J Health Econ. 2018;60:177–197.  https://doi.org/10.1016/j.jhealeco.2018.06.004 CrossRefPubMedGoogle Scholar
  99. 99.
    Pickens G, Karaca Z, Cutler E, et al. Changes in hospital inpatient utilization following health care reform. Health Serv Res. 2018;53(4):2446–2469.  https://doi.org/10.1111/1475-6773.12734 CrossRefPubMedGoogle Scholar
  100. 100.
    Nikpay S, Buchmueller T, Levy HG. Affordable Care Act Medicaid expansion reduced uninsured hospital stays in 2014. Health Aff (Millwood). 2016;35(1):106–110.  https://doi.org/10.1377/hlthaff.2015.1144 CrossRefPubMedGoogle Scholar
  101. 101.
    Freedman S, Nikpay S, Carroll A, Simon K. Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data. PLOS ONE. 2017;12(9):e0183616.  https://doi.org/10.1371/journal.pone.0183616 CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Anderson ME, Glasheen JJ, Anoff D, Pierce R, Lane M, Jones CD. Impact of state Medicaid expansion status on length of stay and in-hospital mortality for general medicine patients at US academic medical centers. J Hosp Med. 2016;11(12):847–852.  https://doi.org/10.1002/jhm.2649 CrossRefPubMedGoogle Scholar
  103. 103.
    Pickens G, Karaca Z, Gibson TB, et al. Changes in hospital service demand, cost, and patient illness severity following health reform. Health Serv Res. 2019;54(4):739–751.  https://doi.org/10.1111/1475-6773.13165 CrossRefPubMedGoogle Scholar
  104. 104.
    Duggan M, Gupta A, Jackson E. The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector. National Bureau of Economic Research; 2019.  https://doi.org/10.3386/w25488
  105. 105.
    Davis MM, Gebremariam A, Ayanian JZ. Changes in Insurance Coverage Among Hospitalized Nonelderly Adults After Medicaid Expansion in Michigan. JAMA. 2016;315(23):2617–2618.  https://doi.org/10.1001/jama.2016.6303 CrossRefPubMedGoogle Scholar
  106. 106.
    Admon AJ, Valley TS, Ayanian JZ, Iwashyna TJ, Cooke CR, Tipirneni R. Trends in Hospital Utilization After Medicaid Expansion. Med Care. 2019;57(4):312.  https://doi.org/10.1097/MLR.0000000000001082 CrossRefPubMedGoogle Scholar
  107. 107.
    Miller S, Wherry LR. Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. N Engl J Med. 2017;376(10):947–956.  https://doi.org/10.1056/NEJMsa1612890 CrossRefPubMedGoogle Scholar
  108. 108.
    Wherry LR, Miller S. Early coverage, access, utilization, and health effects associated with the affordable care act Medicaid expansions: a quasi-experimental study. Ann Intern Med. 2016;164(12):795.  https://doi.org/10.7326/M15-2234 CrossRefPubMedPubMedCentralGoogle Scholar
  109. 109.
    McKenna RM, Langellier BA, Alcalá HE, Roby DH, Grande DT, Ortega AN. The Affordable Care Act Attenuates Financial Strain According to Poverty Level. Inq J Med Care Organ Provis Financ. 2018;55:1–14.  https://doi.org/10.1177/0046958018790164 CrossRefGoogle Scholar
  110. 110.
    Carey CM, Miller S, Wherry LR. The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare. National Bureau of Economic Research; 2018.  https://doi.org/10.3386/w25153
  111. 111.
    Crocker AB, Zeymo A, Chan K, et al. The Affordable Care Act’s Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery. Surgery. 2018;164(6):1156–1161.  https://doi.org/10.1016/j.surg.2018.05.007 CrossRefPubMedGoogle Scholar
  112. 112.
    Shain M, Roemer MI. Hospital costs relate to the supply of beds. Mod Hosp. 1959;92(4):71–73 passim.PubMedGoogle Scholar
  113. 113.
    Fisher ES, Wennberg JE, Stukel TA, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res. 2000;34(6):1351–1362.Google Scholar
  114. 114.
    Zhou M, Oakes AH, Bridges JFP, Padula WV, Segal JB. Regional Supply of Medical Resources and Systemic Overuse of Health Care Among Medicare Beneficiaries. J Gen Intern Med. 2018;33(12):2127–2131.  https://doi.org/10.1007/s11606-018-4638-9 CrossRefPubMedGoogle Scholar
  115. 115.
    Delamater PL, Messina JP, Grady SC, WinklerPrins V, Shortridge AM. Do more hospital beds lead to higher hospitalization rates? A spatial examination of Roemer’s law. PLOS ONE. 2013;8(2):e54900.  https://doi.org/10.1371/journal.pone.0054900 CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Phillip PJ, Mullner R, Andes S. Toward a better understanding of hospital occupancy rates. Health Care Financ Rev. 1984;5(4):53–61.PubMedPubMedCentralGoogle Scholar
  117. 117.
    Green LV. How Many Hospital Beds? Inq J Health Care Organ Provis Financ. 2002;39(4):13.Google Scholar
  118. 118.
    Fahs MC. Physician response to the United Mine Workers’ cost-sharing program: the other side of the coin. Health Serv Res. 1992;27(1):25–45.PubMedPubMedCentralGoogle Scholar
  119. 119.
    Gold R, Bailey SR, OʼMalley JP, et al. Estimating demand for care after a Medicaid expansion: lessons from Oregon. J Ambulatory Care Manage. 2014;37(4):282–292.  https://doi.org/10.1097/JAC.0000000000000023 PubMedCrossRefGoogle Scholar
  120. 120.
    Beck RG, Horne JM. Utilization of publicly insured health services in Saskatchewan before, during and after copayment. Med Care. 1980;18(8):787–806.PubMedCrossRefGoogle Scholar
  121. 121.
    Beck RG. The Effects of Co-Payment on the Poor. J Hum Resour. 1974;9(1):129–142.  https://doi.org/10.2307/145049 CrossRefGoogle Scholar
  122. 122.
    Stoddart GL, Barer ML, Evans RG. User charges, snares and delusions: another look at the literature. December 1993.  https://doi.org/10.14288/1.0048384
  123. 123.
    Glied S, Hong K. Health care in a multi-payer system: Spillovers of health care service demand among adults under 65 on utilization and outcomes in Medicare. J Health Econ. 2018;60:165–176.  https://doi.org/10.1016/j.jhealeco.2018.05.001 CrossRefPubMedPubMedCentralGoogle Scholar
  124. 124.
    McInerney M, Mellor JM, Sabik LM. The Effects of State Medicaid Expansions for Working-Age Adults on Senior Medicare Beneficiaries. Am Econ J Econ Policy. 2017;9(3):408–438.  https://doi.org/10.1257/pol.20150402 CrossRefGoogle Scholar
  125. 125.
    He D, McInerney M, Mellor J. Physician responses to rising local unemployment rates: Healthcare provision to Medicare and privately insured patients. J Health Econ. 2015;40:97–108.  https://doi.org/10.1016/j.jhealeco.2014.12.008 CrossRefPubMedGoogle Scholar
  126. 126.
    Deeble JS. Health Expenditure in Australia: 1960-61 to 1975-76’ Table 11: Public and Private General Hospitals: Capacity and Output Statistics 1960-61 to 1975-76. Canberra: Health Research Project, Australian National University; 1978.Google Scholar
  127. 127.
    PORDATA - Health establishments: appointments, admissions and emergencies. https://www.pordata.pt/en/Portugal/Health+establishments+appointments++admissions+and + emergencies-3321-301255.  Accessed December 11, 2018.
  128. 128.
  129. 129.

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Harvard Medical School Cambridge Health AllianceCambridgeUSA
  2. 2.City University of New York at Hunter CollegeNew YorkUSA

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