Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals.
Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals.
- 2018
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
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. 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. 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. 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.
English
1072-7515
*Continental Population Groups/sn [Statistics & Numerical Data]
*Healthcare Disparities/sn [Statistics & Numerical Data]
*Hospitals/sn [Statistics & Numerical Data]
*Medicaid/sn [Statistics & Numerical Data]
*Neoplasms/su [Surgery]
*Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data]
African Americans/sn [Statistics & Numerical Data]
Databases, Factual/sn [Statistics & Numerical Data]
European Continental Ancestry Group/sn [Statistics & Numerical Data]
Health Services Accessibility/sn [Statistics & Numerical Data]
Health Services Accessibility/st [Standards]
Healthcare Disparities/st [Standards]
Hospitals/st [Standards]
Humans
Neoplasms/ep [Epidemiology]
New York/ep [Epidemiology]
Quality of Health Care/sn [Statistics & Numerical Data]
Quality of Health Care/st [Standards]
United States
MedStar Health Research Institute
Journal Article
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
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. 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. 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. 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.
English
1072-7515
*Continental Population Groups/sn [Statistics & Numerical Data]
*Healthcare Disparities/sn [Statistics & Numerical Data]
*Hospitals/sn [Statistics & Numerical Data]
*Medicaid/sn [Statistics & Numerical Data]
*Neoplasms/su [Surgery]
*Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data]
African Americans/sn [Statistics & Numerical Data]
Databases, Factual/sn [Statistics & Numerical Data]
European Continental Ancestry Group/sn [Statistics & Numerical Data]
Health Services Accessibility/sn [Statistics & Numerical Data]
Health Services Accessibility/st [Standards]
Healthcare Disparities/st [Standards]
Hospitals/st [Standards]
Humans
Neoplasms/ep [Epidemiology]
New York/ep [Epidemiology]
Quality of Health Care/sn [Statistics & Numerical Data]
Quality of Health Care/st [Standards]
United States
MedStar Health Research Institute
Journal Article