Insurance coverage among women diagnosed with a gynecologic malignancy before and after implementation of the Affordable Care Act
Insurance coverage among women diagnosed with a gynecologic malignancy before and after implementation of the Affordable Care Act
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DOI：
10.1016/j.ygyno.2017.06.012
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发表时间：
2017-09-01
影响因子：
4.7
通讯作者：
Chino, Junzo
中科院分区：
文献类型：
--
作者：
Moss, Haley A.;Havrilesky, Laura J.;Chino, Junzo
目标。《患者保护和平价医疗法案》（Patient Protection and Affordable Care Act， ACA）包括了通过扩大医疗补助计划（Medicaid）的资格、为私人保险提供补贴和执行个人强制保险来扩大保险范围的条款。本研究的目的是检验ACA对诊断为妇科恶性肿瘤的妇女的保险率的影响。利用监测、流行病学和最终结果18个登记数据库，确定了2008年至2014年间新诊断为宫颈癌、子宫癌或卵巢癌的妇女。保险费率在ACA通过之前和之后（2011年）以及医疗补助扩张之前（2011年1月1月2013年12月）和之后（2014年1月1月2014年12月）进行了检查，以检查特定条款的影响。然后将2014年选择扩大医疗补助计划的州与未选择扩大医疗补助计划的州之间的保险费率进行比较。在181866名被诊断为宫颈癌、子宫癌或卵巢癌的患者中，2011年之后参加医疗补助计划的患者显著增加。2011年至2014年间，所有癌症类型的未参保率都有显著下降（p = 0.001）。诊断为子宫癌和卵巢癌的未参保率下降了50%（分别为6%至3%和8%至4%）
Objective. The Patient Protection and Affordable Care Act (ACA) included provisions to expand insurance coverage by expanding Medicaid eligibility, providing subsidies of private coverage and enforcing an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among women diagnosed with a gynecologic malignancy.Methods. Using Surveillance, Epidemiology, and End Results 18 registries database, women newly diagnosed with cervical, uterine or ovarian cancer between 2008 and 2014 were identified. Insurance rates were examined before and after the passage of the ACA (2011) as well as before (January 2011 December 2013) versus after (January 2014 December 2014) Medicaid expansion to examine the impact of specific provisions. Rates of insurance were then compared between states that elected for expansion of Medicaid in 2014 vs. those states that had not.Results. Among 181,866 diagnosed with cervical, uterine or ovarian cancer, there was a significant increase in patients enrolled in Medicaid after 2011. Between 2011 and 2014, there was a significant decrease in the rates of uninsured for all cancer types (p = 0.001). Uninsured rates decreased by 50% for those diagnosed with uterine and ovarian cancer (6% to 3% and 8% to 4% respectively, p