TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Shara, Nawar M
TI  - Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals
SN  - 1072-7515
PY  - 2018///
KW  - *Continental Population Groups/sn [Statistics & Numerical Data]
KW  - *Healthcare Disparities/sn [Statistics & Numerical Data]
KW  - *Hospitals/sn [Statistics & Numerical Data]
KW  - *Medicaid/sn [Statistics & Numerical Data]
KW  - *Neoplasms/su [Surgery]
KW  - *Patient Protection and Affordable Care Act/sn [Statistics & Numerical Data]
KW  - African Americans/sn [Statistics & Numerical Data]
KW  - Databases, Factual/sn [Statistics & Numerical Data]
KW  - European Continental Ancestry Group/sn [Statistics & Numerical Data]
KW  - Health Services Accessibility/sn [Statistics & Numerical Data]
KW  - Health Services Accessibility/st [Standards]
KW  - Healthcare Disparities/st [Standards]
KW  - Hospitals/st [Standards]
KW  - Humans
KW  - Neoplasms/ep [Epidemiology]
KW  - New York/ep [Epidemiology]
KW  - Quality of Health Care/sn [Statistics & Numerical Data]
KW  - Quality of Health Care/st [Standards]
KW  - United States
KW  - MedStar Health Research Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
N2  - 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
UR  - https://dx.doi.org/10.1016/j.jamcollsurg.2017.09.012
ER  -