Modeling Health Care Expenditures and Use.

Area of Science:

• Health economics
• Biostatistics
• Public health policy

Background:

• Modeling healthcare expenditures and utilization is complex due to skewed data distributions with many zeros.
• Previous analyses of the Affordable Care Act (ACA) policy effects have limitations in capturing nuanced utilization changes.
• The ACA's young adult expansion presents a natural experiment to study healthcare access and spending patterns.

Purpose of the Study:

• To estimate and interpret the effects of the ACA's young adult expansion on healthcare expenditures and use.
• To apply nonlinear statistical models suitable for skewed healthcare utilization data.
• To compare the impact of the ACA policy on total expenditures, office-based visits, and emergency department visits.

Main Methods:

• Utilized two classes of nonlinear statistical models for healthcare expenditures and counts of healthcare use.
• Employed a two-part or hurdle model to account for the excess zeros and skewness in the data.
• Analyzed data from a natural experiment focusing on the ACA's young adult coverage expansion.

Main Results:

• The ACA policy led to an increase in office-based medical visits.
• Conversely, emergency department visits showed a decrease following the ACA policy implementation.
• Overall healthcare spending was reduced, contrary to some expectations.

Conclusions:

• The ACA's young adult expansion positively influenced preventive and routine care utilization.
• The policy demonstrated a cost-saving effect by reducing more expensive emergency department use.
• Advanced statistical modeling is crucial for accurately assessing the impact of health policies on complex utilization and expenditure patterns.