Year of Publication
2023
College
Public Health
Date Available
4-23-2025
Degree Name
Master of Public Health (M.P.H.)
Advisor
John Lyons
Abstract
Inflammatory bowel disease (IBD) affects over 3 million adults in America, relaying a
need for chronic disease management. Along with 24 other states, Kentucky expanded the
Medicaid program January 1, 2014. We hypothesize, Medicaid expansion adoption results in
reduced emergency healthcare services, and increased elective healthcare services with a
reduction in overall healthcare utilization by individuals in the adult IBD population.
The Hospital Inpatient Discharge and Outpatient Services Database identify encounters
related to ulcerative colitis or Crohn’s disease from 2009-2020, in Kentucky. Patient
demographics, admission type, discharge, length of stay, and hospital charges were compared.
3386 pre-expansion and 24255 post expansion encounters for patients with IBD were
collected for analysis. Pre-expansion 47.4% of patients were electively admitted, compared to
76.0% following (p=0.001). Emergency visits decreased from 36.7% pre to 11.4% post
expansion (p=0.001). Admission following a clinical referral increased from 75.0% to 90.4%
post expansion with a corresponding drop in emergency room admission from 13.1% to 0.4%
(p=0.001). Median hospital costs and length of stay both had significant reduction following
Medicaid expansion.
In the IBD population, Medicaid expansion reduced overall healthcare utilization by
reducing emergency care and increasing usage of elective care pathways.
Recommended Citation
Levy, Brittany, "EFFECT OF MEDICAID EXPANSION ON INFLAMMATORY BOWEL DISEASE AND HEALTHCARE UTILIZATION" (2023). Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.). 372.
https://uknowledge.uky.edu/cph_etds/372
