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Affordable Care Act's Medicaid Expansion on Use of Regionalized Surgery at High-Volume Hospitals.

by Zeymo, Alexander; Chan, Kitty; Shara, Nawar M; Al-Refaie, Waddah B.
Citation: Journal of the American College of Surgeons. 2018 Sep 06.Journal: Journal of the American College of Surgeons.Published: ; 2018ISSN: 1072-7515.Full author list: McDermott J; Zeymo A; Chan K; Ehsan A; Crocker A; Xiao D; Ahluwalia JS; DeLeire T; Shara N; Al-Refaie W.UI/PMID: 30219570.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(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.2018.08.693 (Click here) Abbreviated citation: J Am Coll Surg. 2018 Sep 06.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in utilization of regionalized surgery at high volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the utilization of regionalized surgery at HVH among racial/ethnic minorities and low-income populations.Abstract: STUDY DESIGN: Data from State Inpatient Databases (2012-2014), American Hospital Association Annual Survey Database, and Area Resource File from Health Resources and Services Administration, were used to examine 166,558 non-elderly (ages 18-64) adults at 468 hospitals who underwent one of four regionalized surgical procedures in three expansion (KY, MD, NJ) and two non-expansion states (NC, FL). HVH thresholds were defined using the top quintile of visits per year. Interrupted time series were performed to measure the impact of expansion on utilization rates of regionalized surgery at HVH overall, by race/ethnicity, and by income.Abstract: RESULTS: Overall, ACA's expansion was not associated with accelerated utilization rates of regionalized surgical procedures at HVH (OR 1.016, p=0.297). Disparities in utilization of regionalized surgical procedures at HVH among ethnic/racial minorities and low-income populations were unchanged; minority vs. white (OR 1.034 p value= 0.100); low-income vs. high-income (OR 1.034, p = 0.122).Abstract: CONCLUSIONS: Early findings from ACA's Medicaid expansion revealed no impact on the utilization rates of regionalized surgery at HVH overall or on disparities among vulnerable populations. While these results need ongoing evaluation, they highlight potential limitations in ACA's expansion in reducing disparities in utilization of regionalized surgical care.Abstract: Copyright (c) 2018. Published by Elsevier Inc.

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