Did Pre-Affordable Care Act Medicaid Expansion Increase Access to Surgical Cancer Care?.

MedStar author(s):
Citation: Journal of the American College of Surgeons. 224(4):662-669, 2017 AprPMID: 28130171Institution: MedStar Family Choice | MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleYear: 2017Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007MH - AdultMH - Ethnic GroupsMH - FemaleMH - Health Services Accessibility/ec [Economics]MH - *Health Services Accessibility/lj [Legislation & Jurisprudence]MH - Health Services Accessibility/sn [Statistics & Numerical Data]MH - Health Services Accessibility/td [Trends]MH - Healthcare Disparities/ec [Economics]MH - *Healthcare Disparities/eh [Ethnology]MH - Healthcare Disparities/sn [Statistics & Numerical Data]MH - Healthcare Disparities/td [Trends]MH - HumansMH - MaleMH - *Medicaid/lj [Legislation & Jurisprudence]MH - Medically Uninsured/sn [Statistics & Numerical Data]MH - Middle AgedMH - Minority GroupsMH - Neoplasms/ec [Economics]MH - *Neoplasms/su [Surgery]MH - New YorkMH - *Patient Protection and Affordable Care ActMH - Retrospective StudiesMH - Surgical Procedures, Operative/ec [Economics]MH - Surgical Procedures, Operative/sn [Statistics & Numerical Data]MH - Surgical Procedures, Operative/td [Trends]MH - *Surgical Procedures, Operative/ut [Utilization]MH - United StatesISSN:
  • 1072-7515
Name of journal: Journal of the American College of SurgeonsAbstract: BACKGROUND: Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York's 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities.CONCLUSIONS: Pre-ACA Medicaid expansion did not increase the overall use or change the racial composition of beneficiaries of surgical cancer care. However, it successfully shifted the financial burden away from patient/hospital to Medicaid. These results might suggest similar effects in the post-ACA Medicaid expansion.Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.RESULTS: The proportion of cancer operations paid by Medicaid increased from 8.9% to 15.1% in the 5 years after the expansion. The percentage of uninsured patients dropped by 21.3% immediately after the expansion (p = 0.01). Although the expansion was associated with a 24-case/year increase in the net Medicaid case volume (p < 0.0001), the overall all-payer net case volume remained unchanged. In addition, the adjusted percentage of ethnic minorities among Medicaid recipients of cancer surgery was unaffected by the expansion.STUDY DESIGN: From the New York State Inpatient Database (1997 to 2006), we identified 67,685 nonelderly adults (18 to 64 years of age) who underwent cancer surgery. Estimated effects of 2001 Medicaid expansion on access were measured on payer mix, overall use of surgical cancer care, and percent use by racial/ethnic minorities. Measures were calculated quarterly, adjusted for covariates when appropriate, and then analyzed using interrupted time series.All authors: Al-Refaie WB, Clements ML, DeLeire T, Jindal M, Johnson LB, Shara N, Toye P, Westmoreland T, Xiao D, Zheng CFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28130171 Available 28130171

Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007MH - AdultMH - Ethnic GroupsMH - FemaleMH - Health Services Accessibility/ec [Economics]MH - *Health Services Accessibility/lj [Legislation & Jurisprudence]MH - Health Services Accessibility/sn [Statistics & Numerical Data]MH - Health Services Accessibility/td [Trends]MH - Healthcare Disparities/ec [Economics]MH - *Healthcare Disparities/eh [Ethnology]MH - Healthcare Disparities/sn [Statistics & Numerical Data]MH - Healthcare Disparities/td [Trends]MH - HumansMH - MaleMH - *Medicaid/lj [Legislation & Jurisprudence]MH - Medically Uninsured/sn [Statistics & Numerical Data]MH - Middle AgedMH - Minority GroupsMH - Neoplasms/ec [Economics]MH - *Neoplasms/su [Surgery]MH - New YorkMH - *Patient Protection and Affordable Care ActMH - Retrospective StudiesMH - Surgical Procedures, Operative/ec [Economics]MH - Surgical Procedures, Operative/sn [Statistics & Numerical Data]MH - Surgical Procedures, Operative/td [Trends]MH - *Surgical Procedures, Operative/ut [Utilization]MH - United States

BACKGROUND: Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York's 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities.

CONCLUSIONS: Pre-ACA Medicaid expansion did not increase the overall use or change the racial composition of beneficiaries of surgical cancer care. However, it successfully shifted the financial burden away from patient/hospital to Medicaid. These results might suggest similar effects in the post-ACA Medicaid expansion.

Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

RESULTS: The proportion of cancer operations paid by Medicaid increased from 8.9% to 15.1% in the 5 years after the expansion. The percentage of uninsured patients dropped by 21.3% immediately after the expansion (p = 0.01). Although the expansion was associated with a 24-case/year increase in the net Medicaid case volume (p < 0.0001), the overall all-payer net case volume remained unchanged. In addition, the adjusted percentage of ethnic minorities among Medicaid recipients of cancer surgery was unaffected by the expansion.

STUDY DESIGN: From the New York State Inpatient Database (1997 to 2006), we identified 67,685 nonelderly adults (18 to 64 years of age) who underwent cancer surgery. Estimated effects of 2001 Medicaid expansion on access were measured on payer mix, overall use of surgical cancer care, and percent use by racial/ethnic minorities. Measures were calculated quarterly, adjusted for covariates when appropriate, and then analyzed using interrupted time series.

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