Decomposing Medicaid Spending During Health System Reform and ACA Expansion: Evidence From Oregon

Medical Care
Stephanie RenfroK John McConnell

Abstract

Expansion of the Medicaid program is likely to create new budgetary pressures at the state and federal levels, creating a need for greater understanding of how program dollars are allocated and what drives spending growth. To characterize Oregon Medicaid expenditures across diseases and medical conditions, during periods of payment reform and coverage expansion. Decomposition of changes in Medicaid expenditures using a person-based allocation of spending across 50 diseases/medical conditions. Four indices describe changes in costs per enrolled member, demographic shifts, prevalence of treated disease/condition, and costs per treated member. Oregon Medicaid beneficiaries during 2011 (N=597,422), 2013 (N=614,858), and 2014 (N=978,237). Expenditures on pregnancy/birth and mental conditions accounted for 24% of 2011 spending. Oregon's 2012 payment reform was associated with reduced spending attributable primarily to decreased prevalence of treated conditions. The 2014 Medicaid expansion was marked by lower pregnancy and mental health expenditures and higher spending on treatment for substance use and heart disease. Medicaid spending is concentrated among a small group of medical conditions, not all of which are typically associated...Continue Reading

References

Sep 29, 2004·Health Affairs·Kenneth E ThorpePeter Joski
Sep 20, 2007·Health Affairs·John Holahan
Feb 6, 2008·Health Services Research·Justin G TrogdonThomas J Hoerger
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Jun 15, 2017·The New England Journal of Medicine·K John McConnell, Michael E Chernew

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