本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.27014

摘要内容如下：

重要性

卫生部门财政的变化在多大程度上影响卫生保健工作者，特别是低收入工作者的经济成果尚不清楚。

目的

评估各州采用《平价医疗法案》（Affordable Care Act）的医疗补助计划（Medicaid）扩展（这导致医疗保健组织的财务状况大幅改善）与医疗保健工作者的年收入和福利之间的关联，以及这些关联是否因低工资和高工资职业而异。

设计、设置和参与者

在2010-2019年美国社区调查中，通过对18至65岁的美国医疗保健行业从业人员进行调查，进行差异分析，以评估医疗补助计划扩大前后30个州的医疗保健工作者相对于16个未扩大医疗补助计划的州的医疗保健工作者的经济结果的差异变化。

曝光

医疗补助扩展的时变州级采用。

主要成果和措施

主要结果是年收入；次要结果包括接受雇主赞助的健康保险、医疗补助和补充营养援助计划福利。

结果

样本包括2010-2019年的1322263名医护人员。扩展州的卫生保健工作者在年龄、性别和教育程度方面与非扩展州的卫生保健工作者相似，但扩展州的卫生保健工作者不太可能被认定为非西班牙裔黑人。医疗补助扩展与年收入增加2.16%相关（95%CI，0.66%-3.65%；P=.005）。这一效应是由收入最高的两个五分位数（β系数，2.91%-3.72%）的年收入显著增加所驱动的，其中包括注册护士、医生和管理人员。收入较低的五分之一人口中的卫生保健工作者没有经历任何重大变化。医疗补助扩展与卫生保健工作者获得医疗补助福利的可能性增加3.15个百分点相关（95%CI，2.46至3.84；P<.001），在收入最低的两个五分位数中增幅最大，其中包括健康助理、护理员和环卫工人。随着医疗补助计划（Medicaid）的扩大，雇主赞助的医疗保险显著减少，而SNAP则有所增加。

结论和相关性

医疗补助计划（Medicaid）的扩大与医护人员薪酬的增加有关，但仅限于收入最高的人群。这些研究结果表明，卫生保健部门财务状况的改善可能会增加卫生保健工作者之间的经济不平等，从而对工作者的健康和福祉产生影响。

英文原文如下：

Abstracts

Importance  The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known.

Objective  To assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations.

Design, Setting, and Participants  Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys.

Exposure  Time-varying state-level adoption of Medicaid expansion.

Main Outcomes and Measures  Primary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits.

Results  The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion.

Conclusion and Relevance  Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.

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