摘要：Objectives. We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina. Methods. We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data. Results. Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services. Conclusions. Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population. The short-term effect of natural disasters has received considerable attention from the public health community. 1– 6 Disasters can have devastating economic consequences and a substantial impact on the incidence of disease and injuries. Natural disasters are shocks to both the supply and demand of health services. On the supply side, natural disasters can profoundly affect the delivery of services; facilities may experience diminished staff levels and capacity because of damaged buildings and supplies. Supply-side shocks reduce service availability, an effect mitigated somewhat as temporary services become available. For example, Alson and colleagues examined services provided by a temporary field hospital after Hurricane Andrew 7 and found that most services provided were not storm related but were routine medical services. Demand-side shocks from natural disasters can either increase or decrease demand for care; short- and long-term effects may be different. Disasters can increase disease and injury incidence and acute levels of distress, 8– 10 thereby increasing service demand. Disasters can reduce demand as the costs of travel to facilities increase; time costs generally increase owing to competing needs such as home reconstruction, and the provision of substitute low-cost services increases. The long-term effects of natural disasters on the use of medical services are not easily determined or well studied. One of the few extant reports examined changes in health care use resulting from the 1968 floods in Bristol, England 11 ; it found significantly more hospital use during the year after the floods by residents with flooded houses than by those in the control group. Abrahams and colleagues found that after an Australian flood, the percentage of persons consulting their physician 3 or more times during the year following the flood was significantly higher than in a matched control group. 12 We report here on the impact of a natural disaster, Hurricane Floyd, which affected North Carolina and other US states. We determine the effect of the hurricane and flooding on Medicaid enrollment and use of health services among Medicaid enrollees in the most severely affected North Carolina counties. Specifically, we (1) assess the impact of Hurricane Floyd on Medicaid enrollment, (2) determine its impact on the use of health services by Medicaid enrollees, and (3) examine trends in use in the weeks, months, and year after the hurricane.
