ACA Medicaid expansion reduced disparities in use of high-volume hospitals for pancreatic surgery.

MedStar author(s):
Citation: Surgery. 170(6):1785-1793, 2021 12.PMID: 34303545Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Health Services Accessibility/sn [Statistics & Numerical Data] | *Hospitals, High-Volume/sn [Statistics & Numerical Data] | *Pancreatectomy/sn [Statistics & Numerical Data] | *Pancreatic Neoplasms/su [Surgery] | *Patient Protection and Affordable Care Act/lj [Legislation & Jurisprudence] | Adult | Female | Health Services Accessibility/ec [Economics] | Health Services Accessibility/lj [Legislation & Jurisprudence] | Health Services Accessibility/td [Trends] | Healthcare Disparities/sn [Statistics & Numerical Data] | Healthcare Disparities/td [Trends] | Hospitals, High-Volume/td [Trends] | Humans | Male | Medicaid/ec [Economics] | Medicaid/lj [Legislation & Jurisprudence] | Middle Aged | Pancreatectomy/ec [Economics] | Pancreatectomy/td [Trends] | Pancreatic Neoplasms/ec [Economics] | Referral and Consultation/ec [Economics] | Referral and Consultation/sn [Statistics & Numerical Data] | Referral and Consultation/td [Trends] | United StatesYear: 2021ISSN:
  • 0039-6060
Name of journal: SurgeryAbstract: BACKGROUND: Early evaluation of the Affordable Care Act's Medicaid expansion demonstrated persistent disparities among Medicaid beneficiaries in use of high-volume hospitals for pancreatic surgery. Longer-term effects of expansion remain unknown. This study evaluated the impact of expansion on the use of high-volume hospitals for pancreatic surgery among Medicaid and uninsured patients.CONCLUSION: Medicaid expansion was associated with greater utilization of high-volume hospitals for pancreatic surgery among Medicaid and uninsured patients. These findings are informative to non-expansion states considering expansion. Future studies should target understanding referral mechanism post-expansion. Copyright (c) 2021 Elsevier Inc. All rights reserved.METHODS: State inpatient databases (2012-2017), the American Hospital Association Annual Survey Database, and the Area Resource File from the Health Resources and Services Administration, were used to examine 8,264 non-elderly adults who underwent pancreatic surgery in nine expansion and two non-expansion states. High-volume hospitals were defined as performing 20 or more resections/year. Linear probability triple differences models measured pre- and post-Affordable Care Act utilization rates of pancreatic surgery at high-volume hospitals among Medicaid and uninsured patients versus privately insured patients in expansion versus non-expansion states.RESULTS: The Affordable Care Act's expansion was associated with increased rates of utilization of high-volume hospitals for pancreatic surgery by Medicaid and uninsured patients (48% vs 55.4%, P = .047) relative to privately insured patients in expansion states (triple difference estimate +11.7%, P = .022). A pre-Affordable Care Act gap in use of high-volume hospitals among Medicaid and uninsured patients in expansion states versus non-expansion states (48% vs 77%, P < .0001) was reduced by 15.1% (P = .001) post Affordable Care Act. A pre Affordable Care Act gap between expansion versus non-expansion states was larger for Medicaid and uninsured patients relative to privately insured patients by 24.9% (P < .0001) and was reduced by 11.7% (P = .022) post Affordable Care Act. Rates among privately insured patients remained unchanged.All authors: Al-Refaie WB, Aminpour N, DeLia D, Desale S, McDermott J, Mishra A, Zeymo AOriginally published: Surgery. 2021 Jul 21Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34303545 Available 34303545

BACKGROUND: Early evaluation of the Affordable Care Act's Medicaid expansion demonstrated persistent disparities among Medicaid beneficiaries in use of high-volume hospitals for pancreatic surgery. Longer-term effects of expansion remain unknown. This study evaluated the impact of expansion on the use of high-volume hospitals for pancreatic surgery among Medicaid and uninsured patients.

CONCLUSION: Medicaid expansion was associated with greater utilization of high-volume hospitals for pancreatic surgery among Medicaid and uninsured patients. These findings are informative to non-expansion states considering expansion. Future studies should target understanding referral mechanism post-expansion. Copyright (c) 2021 Elsevier Inc. All rights reserved.

METHODS: State inpatient databases (2012-2017), the American Hospital Association Annual Survey Database, and the Area Resource File from the Health Resources and Services Administration, were used to examine 8,264 non-elderly adults who underwent pancreatic surgery in nine expansion and two non-expansion states. High-volume hospitals were defined as performing 20 or more resections/year. Linear probability triple differences models measured pre- and post-Affordable Care Act utilization rates of pancreatic surgery at high-volume hospitals among Medicaid and uninsured patients versus privately insured patients in expansion versus non-expansion states.

RESULTS: The Affordable Care Act's expansion was associated with increased rates of utilization of high-volume hospitals for pancreatic surgery by Medicaid and uninsured patients (48% vs 55.4%, P = .047) relative to privately insured patients in expansion states (triple difference estimate +11.7%, P = .022). A pre-Affordable Care Act gap in use of high-volume hospitals among Medicaid and uninsured patients in expansion states versus non-expansion states (48% vs 77%, P < .0001) was reduced by 15.1% (P = .001) post Affordable Care Act. A pre Affordable Care Act gap between expansion versus non-expansion states was larger for Medicaid and uninsured patients relative to privately insured patients by 24.9% (P < .0001) and was reduced by 11.7% (P = .022) post Affordable Care Act. Rates among privately insured patients remained unchanged.

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