All ETDs from UAB

Advisory Committee Chair

Allyson Hall

Advisory Committee Members

Sandra Chaisson Brown

Patrick Grusenmeyer

Jeff Szychowski

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Two significant events transpired in Louisiana that had sweeping changes for the healthcare system between 2013 and 2016: (1) the privatization of the nation's only stateowned Charity Hospital System via cooperative endeavor agreements with local, private hospitals known as public-private-partnerships (PPP), and (2) the implementation of Medicaid expansion, referred to as implementation of the Affordable Care Act (ACA). Either event independently could have had significant utilization and financial implications for hospitals. This retrospective, quasi-experimental research implemented a generalized estimating equation (GEE) analysis to examine the effects of PPP and ACA on Medicaid patient emergency department utilization by PPP hospital designation, PPP hospitals and non-PPP hospitals, in Louisiana from January 2011 to December 2016 and January 2012 to December 2019, respectively. Findings suggest that Louisiana is still challenged by Medicaid patients’ historical reliance on hospital EDs. Post-PPP, Charity/PPP hospitals saw modest increases in Medicaid ED volumes with Region 4 being the exception. Region 4 Charity/PPP hospital saw a decrease in ED utilization post-PPP. Both PPP and non-PPP hospitals saw sharp increases in Medicaid ED utilization patterns from pre- to post-ACA, but non-PPP, nonrural hospitals do not enjoy the same political protections and enhanced reimbursement as iv their counterparts. The net effect of PPP and ACA implementation on PPP hospitals saw statistically significant increases in Medicaid ED visits in every region compared to the non-PPP hospitals. Overall, pre- and post-ACA, quantifiable Medicaid ED visit growth in PPP hospitals surpassed those of non-PPP hospitals, but non-PPP hospitals still provided the majority of Medicaid ED visits. Strong associations between social determinants of health (SDoH) and Medicaid ED utilization have been identified that are consistent with other research (McCarthy et al., 2019). One key finding was statistically significant Area Deprivation Index (ADI) in Region 8. This suggests high ED utilization could demonstrate lack of access for low income Louisianans. While Louisiana Medicaid ED visits may only represent approximately 1% of total Medicaid expenditures in 2022, contextual reasons for ED utilization can be a window into the causes fueling the growth for the other 99% of the escalating Medicaid expenditures.



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