July 5, 2017

ACA coverage expansions led to fewer out-of-hospital cardiac arrests, study finds

Daily Briefing

    The rate of out-of-hospital cardiac arrests in Oregon fell significantly after the Affordable Care Act's (ACA) coverage expansions took effect, according to a study published last week in the Journal of the American Heart Association..

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    Study details

    For the study, researchers compared data on cardiac arrests from the emergency medical system in Oregon's Multnomah County from 2011 to 2012, before the ACA's coverage expansions took effect, with data from 2014 and 2015, after the ACA's coverage expansions took effect. The researchers looked at data on individuals ages 45 and older.

    Findings

    The researchers found the rate of out-of-hospital cardiac arrests that occurred in the county dropped by 17 percent among individuals ages 45 to 64. According to the study, the uninsured rate among that age group decreased by nearly half after the ACA's coverage expansions took effect.

    The researchers largely attributed the reduction in the group's uninsured rate to the state's Medicaid expansion under the ACA. In addition, the researchers found the rate of individuals directly purchasing insurance increased from 8.2 percent before the ACA to 10 percent after the law's implementation.

    According to the researchers, the rate of out-of-hospital cardiac arrests in the county among individuals ages 65 and older did not change, as the rate of uninsured elderly individuals remained low and steady.

    Discussion

    Lead study author Eric Stecker of the Oregon Health and Science University said he was surprised by "the degree of benefit" coverage expansions had on out-of-hospital cardiac arrest rates among individuals ages 45 to 64.

    Sumeet Chugh, a co-author of the study and a medical director of the Heart Rhythm Center at Cedars-Sinai Heart Institute, said insured individuals "might be more inclined to see a [health care] provider" if they experience "warning symptom[s]" of cardiac arrest, whereas uninsured individuals "might let it go for a while." Still, he cautioned that the study population was small, and that the study did not examine other factors that could have contributed to the decline in cardiac arrest rates.

    Mary Fran Hazinski of Vanderbilt University School of Nursing, who co-authored an editorial accompanying the study, said one factor which could have contributed to the reduction in out-of-hospital cardiac arrests was Oregon's health care delivery and payment innovation efforts, which included establishing patient-centered primary care homes with "an integrated system of regional coordinated care organizations that were required to follow evidence-based guidelines and monitor quality of care and cost-effectiveness."

    She added, "Health care coverage, alone, is not a panacea," although "expanded health care coverage can save lives when provided in a system that promotes best practices and carefully monitors quality and costs" (Gold, Kaiser Health News, 6/28; Boggs, Reuters, 6/28).

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