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<<   作成日時 : 2012/07/27 20:02   >>

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メディケイドを拡張した州で死亡率が減少/米国医療事情
 米国の貧困者向け健康保険メディケイドの拡張を行った州では成人の死亡率が6%以上減少した。
 20-65才の成人についてCDCのデータをもとに、拡張したニューヨーク、メイン州とアリゾナ州の3州と、拡張しなかった近隣のペンシルベニア州、ニューハンプシャー州とネバダ・ニューメキシコ州を拡張前後の5年間を比較した。100,000人当たり19.6人、6.1パーセントの死亡減少が原因にかかわらずみられた。メディケイドの拡張州では年間2840人の死亡を防いだ。
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Medicaid expansion in U.S. states found to cut death rates
http://www.reuters.com/article/2012/07/25/us-usa-medicaid-study-idUSBRE86O1OU20120725

By Lewis Krauskopf
Wed Jul 25, 2012 5:21pm EDT
(Reuters) - State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday.

The findings published in the New England Journal of Medicine could fuel a political furor over new plans for a nationwide expansion of Medicaid that erupted after the U.S. Supreme Court's ruling to uphold President Barack Obama's healthcare law in late June.

In an unexpected move, the high court ruling also left it up to states to decide whether to participate in the law's broader eligibility criteria for Medicaid that would extend insurance coverage to as many as 16 million more Americans starting in 2014. At least five Republican governors who opposed the healthcare law have vowed to opt out of the expansion, saying the program will pose a huge financial burden.

The lead author of the study was Benjamin Sommers, an assistant professor in health policy and economics at the Harvard School of Public Health who is temporarily working as an advisor to the U.S. Department of Health and Human Services. According to a disclosure note in the study, the paper was conceived and drafted while Sommers was employed at Harvard and the findings do not reflect official U.S. government policy.

The study examined three states that substantially broadened Medicaid eligibility for adults since 2000 -- New York, Maine and Arizona. They were compared to neighboring states that did not implement expansions -- Pennsylvania (for New York), New Hampshire (for Maine) and Nevada and New Mexico (for Arizona).

Adults between the ages of 20 and 64 years old were studied for five years before and after the expansion, using data from the U.S. Centers for Disease Control and Prevention.

Medicaid expansions were associated with a reduction in mortality from all causes, by 19.6 deaths per 100,000 adults, for a 6.1 percent decrease compared to the states without expansions.

The mortality declines were greatest among adults between ages 35 and 64, minorities and residents of poor counties.

The expansions also led to decreased rates of uninsurance, lower rates of delayed care because of costs, and an increase in the rate of people reporting their health status as "excellent" or "very good".

"The takeaway is that state expansions of Medicaid coverage to adults appear to be effective at improving both access to care and health for low-income Americans," Sommers said in an interview.

The results corresponded to 2,840 deaths prevented per year in the states with Medicaid expansions. That figure suggests that 176 additional adults would need to be covered by Medicaid in order to prevent one death per year, according to the study.

(Reporting by Lewis Krauskopf; Editing by Michele Gershberg and Carol Bishopric)

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Mortality and Access to Care among Adults after State Medicaid Expansions
Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D.
(DOI: 10.1056/NEJMsa1202099)

Background
Several states have expanded Medicaid eligibility for adults in the past decade, and the Affordable Care Act allows states to expand Medicaid dramatically in 2014. Yet the effect of such changes on adults’ health remains unclear. We examined whether Medicaid expansions were associated with changes in mortality and other healthrelated measures.
Methods
We compared three states that substantially expanded adult Medicaid eligibility since 2000 (New York, Maine, and Arizona) with neighboring states without expansions.
The sample consisted of adults between the ages of 20 and 64 years who were observed 5 years before and after the expansions, from 1997 through 2007. The primary outcome was all-cause county-level mortality among 68,012 year- and countyspecific observations in the Compressed Mortality File of the Centers for Disease
Control and Prevention. Secondary outcomes were rates of insurance coverage, delayed care because of costs, and self-reported health among 169,124 persons in the Current Population Survey and 192,148 persons in the Behavioral Risk Factor Surveillance System.
Results
Medicaid expansions were associated with a significant reduction in adjusted allcause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported health status of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04).
Conclusions
State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and selfreported health.

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