The Association Between the Affordable Care Act and Insurance Status, Stage and Treatment in Patients with Testicular Cancer.
The Association Between the Affordable Care Act and Insurance Status, Stage and Treatment in Patients with Testicular Cancer.
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DOI：
10.1097/upj.0000000000000109
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发表时间：
2020-07
期刊：
影响因子：
0.8
通讯作者：
Leapman MS
中科院分区：
文献类型：
--
作者：
Hsiang W;Han X;Jemal A;Nguyen KA;Shuch B;Park H;Yu JB;Gross CP;Davidoff AJ;Leapman MS
我们的目的是确定通过平价医疗法案(ACA)实施的保险扩展是否与患有睾丸生殖细胞肿瘤(GCT)的年轻人的保险状况、疾病阶段和治疗的变化有关。我们在国家癌症数据库中确定了2010年至2015年间确诊为睾丸GCTS的18岁男性。我们将时间段定义为：ACA前(2010-2013)和ACA后(2014-2015)，并使用差异(DID)建模来检查州医疗补助扩展状况与保险、诊断和治疗阶段变化之间的关系。在ACA之后，在医疗补助扩展州和非扩展州，拥有任何医疗保险的患者比例分别增加了3.7%(95%CI 3-4.5)和3.0%(95%CI 1.5-4.5)，主要是通过获得医疗补助和私人保险。增幅最大的是低收入患者，在ACA之后，医疗补助的扩大与医疗补助覆盖面调整后增加了14.5个百分点(95%CI 7.2-21.8)相关。在观察期内，我们没有观察到晚期诊断的减少。在ACA之前，接受化疗或放射治疗的晚期癌症患者的比例一直在变化，在扩张和非扩张状态之间存在差异，限制了对ACA相关个体治疗影响的评估。ACA后，新诊断的有医疗保险的睾丸癌患者的比例增加，最低收入的人受到的影响最大。我们的发现是，实践中的变化早于ACA，而且在扩大地位方面存在差异，这突出表明在评估立法的影响时需要谨慎。
We aimed to determine whether insurance expansions implemented through the Affordable Care Act (ACA) were associated with changes in coverage status, disease stage, and treatment of younger adults with testicular germ cell tumors (GCT). We identified men aged 18–64 diagnosed with testicular GCTs between 2010 and 2015 in the National Cancer Data Base. We defined time periods as: pre-ACA (2010–2013) and post-ACA (2014–2015) and used difference-in-differences (DID) modeling to examine associations between state Medicaid expansion status and changes in insurance, stage at diagnosis, and treatment. Following the ACA, the proportion of patients with any health insurance increased 3.7% (95% CI 3–4.5) in Medicaid expansion states and 3.0% (95% CI 1.5–4.5) in non-expansion states, mainly by gaining Medicaid and private insurance, respectively. The largest increases occurred in low-income patients, where Medicaid expansion was associated with an adjusted increase of 14.5 percentage points (95% CI 7.2–21.8) in Medicaid coverage following the ACA. We did not observe reductions in late-stage diagnoses during the observation period. Changes in the proportion of patients receiving chemotherapy or radiation for advanced-stage cancers were ongoing prior to the ACA and differed between expansion and non-expansion states, limiting assessment of ACA-related effects on individual treatments. Post-ACA, the proportion of newly diagnosed testicular cancer patients with health insurance increased, with the largest effects seen among lowest income individuals. Our findings that changes in practice preceded the ACA and differed by expansion status highlight the need for caution in assessing the legislation’s impact.