'Medicare for All' unlikely to increase hospital use, study suggests

Proposals to cover Americans under a "Medicare for All" system wouldn't result in a net increase in hospital use, according to a study published in the Annals of Internal Medicine.

For the study, researchers from Harvard Medical School in Boston and the City University of New York at Hunter College in New York City analyzed how past insurance expansions, like the implementation of Medicare and Medicaid in 1966 and the ACA in 2014, affected hospital use. They drew data from large national surveys from the Medicare/Medicaid and ACA eras and analyzed hospital use before and after the expansions.

Researchers found hospital admissions averaged 12.8 per 100 people in the three years before Medicare/Medicaid, and 12.7 per 100 in the four years after the program's rollout. Additionally, hospital admissions averaged 9.4 per 100 in the six years before the ACA, and 9 per 100 in the two years afterward.

While net hospital use didn't increase, researchers did uncover a redistribution of care. Increase in hospital use among newly insured Americans was offset by small decreases in hospital use among Americans who were healthier and wealthier.

Researchers said a limited supply of hospital beds may have constrained the overall use of hospitals under the coverage expansions. The study authors also said their analysis was limited to data sources that relied on participant recall, surveys that excluded institutionalized Americans and limited follow-up data post-ACA. The study authors are also linked with the Physicians for a National Health Program, a nonprofit organization favoring single-payer coverage expansions, though PNHP said it did not fund or support the study.

"Past coverage expansions were associated with little or no change in society-wide hospital use; increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use," the researchers concluded. "Reducing coverage may merely shift care toward wealthier and healthier persons. Conversely, universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained."

To read the full study, click here.

Editor's note: This article was updated July 23 to include information about the researchers' link to the Physicians for a National Health Program.

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