This study examines the unintended consequences of healthcare inclusion policies, specifically the 2014 Medicaid expansion under the Affordable Care Act (ACA), on hospital efficiency and resource allocation in New York State. Using a quasi-experimental difference-in-differences (DiD) design, we analyze longitudinal data from the Healthcare Cost and Utilization Project (HCUP) and New York’s Statewide Planning and Research Cooperative System (SPARCS) spanning 2008–2018. Regions were matched via propensity score matching (PSM) and covariate exact matching (CEM), with Mohawk Valley (treatment) and North Country (control) selected for comparative analysis. Poisson and log-linear fixed-effects models reveal significant saturation effects post-expansion: • Medicare/Medicaid patient surge: A 53% increase in Medicare (DID = 0.383, p < 0.01) and 127% rise in Medicaid admissions (DID = 0.838, p < 0.05) in treated regions. • Operational strain: Length of stay (LOS) increased by 0.74 days (β = 0.74, p < 0.05), while private insurance admissions declined by 15%, indicating coverage substitution. • Resource trade-offs: Despite reduced uninsured rates (-28%), hospitals faced capacity constraints, highlighting inefficiencies from unplanned resource scaling. The findings support the inclusion-induced saturation hypothesis, where rapid coverage expansion strains infrastructure without proportional capacity investments. Policy implications emphasize the need for integrated resource planning to balance equity and operational sustainability.
저자
Cesar Fonseca Ibarra [ Graduate School of Global Digital Innovation, KAIST, South Korea ]
Lee, Chulho [ Graduate School of Global Digital Innovation, KAIST, South Korea ]
