MedStar Authors catalog › Details for: Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals.
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Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals.

by Shara, Nawar M; Al-Refaie, Waddah B.
Citation: Journal of the American College of Surgeons. 226(1):22-29, 2018 01..Journal: Journal of the American College of Surgeons.Published: ; 2018ISSN: 1072-7515.Full author list: Xiao D; Zheng C; Jindal M; Johnson LB; DeLeire T; Shara N; Al-Refaie WB.UI/PMID: 28987635.Subject(s): African Americans/sn [Statistics & Numerical Data] | *Continental Population Groups/sn [Statistics & Numerical Data] | Databases, Factual/sn [Statistics & Numerical Data] | European Continental Ancestry Group/sn [Statistics & Numerical Data] | Health Services Accessibility/st [Standards] | Health Services Accessibility/sn [Statistics & Numerical Data] | Healthcare Disparities/st [Standards] | *Healthcare Disparities/sn [Statistics & Numerical Data] | Hospitals/st [Standards] | *Hospitals/sn [Statistics & Numerical Data] | Humans | *Medicaid/sn [Statistics & Numerical Data] | Neoplasms/ep [Epidemiology] | *Neoplasms/su [Surgery] | New York/ep [Epidemiology] | *Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data] | Quality of Health Care/st [Standards] | Quality of Health Care/sn [Statistics & Numerical Data] | United StatesInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jamcollsurg.2017.09.012 (Click here) Abbreviated citation: J Am Coll Surg. 226(1):22-29, 2018 01.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: The Affordable Care Act's (ACA) Medicaid expansion has been heavily debated due to skepticism of Medicaid's ability to provide high-quality care. Particularly, little is known whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in pre-ACA era, on this disparity measure.Abstract: METHODS: We identified 67,685 nonelderly adults from the New York State Inpatient Database who underwent select cancer resections. High-quality hospitals were defined as high-volume hospitals or low-mortality. Disparity was defined as model-adjusted difference in percentage of patients operated at high-quality hospitals by insurance type (Medicaid/uninsured vs. privately insured) or by race (African-American vs. white). Levels of disparity were calculated quarterly for each comparison pair, then analyzed using interrupted time series to evaluate the impact of Medicaid expansion.Abstract: RESULTS: Disparity in access to high-volume hospitals by insurance type was reduced by 0.61 percentage points per quarter following expansion (p=0.003). Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured; no significant change was detected around expansion. Conversely, racial disparity increased by 0.86 percentage points per quarter (p<0.001) in access to high-volume hospitals and by 0.48 percentage points per quarter (p=0.005) in access to low-mortality hospitals following Medicaid expansion.Abstract: CONCLUSION: Pre-ACA Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with increased racial disparity in access to high-quality hospitals. Addressing racial barriers in access to high-quality hospitals should be prioritized. Copyright (c) 2017. Published by Elsevier Inc.

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