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
复制标题
DOI：
10.1016/j.jamcollsurg.2017.09.012
复制
发表时间：
2018-01-01
影响因子：
5.2
通讯作者：
Al-Refaie, Waddah B.
中科院分区：
文献类型：
--
作者：
Xiao, David;Zheng, Chaoyi;Al-Refaie, Waddah B.
背景：由于对医疗补助提供高质量医疗服务的能力持怀疑态度，《平价医疗法案》的医疗补助扩张一直备受争议。特别是，人们对医疗补助的扩大是否能改善高质量医院获得外科癌症护理的机会知之甚少。为了解决这个问题，我们研究了 2001 年纽约医疗补助扩张（《平价医疗法案》之前时代最大的一次）对这种差异衡量标准的影响。 研究设计：我们从纽约州住院患者数据库中确定了 67,685 名接受过选择性癌症切除术的非老年成年人。高质量医院被定义为高容量或低死亡率的医院。差异被定义为按保险类型（医疗补助/无保险与私人保险）或种族（非裔美国人与白人）划分的在高质量医院接受手术的患者百分比的模型调整差异。每季度计算每个比较对的差异水平，然后使用中断时间序列进行分析，以评估医疗补助扩张的影响。结果：医疗补助扩张后，按保险类型进入大容量医院的差异每季度减少 0.97 个百分点 (p < 0.0001)。医疗补助/未参保受益人与私人参保人一样可以进入低死亡率医院；在扩张方面没有发现重大变化。相反，在医疗补助扩大后，进入大容量医院的种族差距每季度增加 0.87 个百分点 (p < 0.0001)，进入低死亡率医院的种族差距每季度增加 0.48 个百分点 (p = 0.005)。结论：《平价医疗法案》之前的医疗补助扩大减少了付款人在大容量医院获得外科癌症护理的差距。然而，这与进入高质量医院的种族差距扩大有关。应优先解决进入高质量医院的种族障碍。 (C) 2017 年，美国外科医生学会。由爱思唯尔公司出版。保留所有权利。
BACKGROUND: The Affordable Care Act's Medicaid expansion has been heavily debated due to skepticism about Medicaid's ability to provide high-quality care. Particularly, little is known about 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 the pre-Affordable Care Act era, on this disparity measure.STUDY DESIGN: 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 or low-mortality hospitals. Disparity was defined as model-adjusted difference in percentage of patients receiving operations 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 and 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 0.97 percentage points per quarter after Medicaid expansion (p < 0.0001). 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 0.87 percentage points per quarter (p < 0.0001) in access to high-volume hospitals and by 0.48 percentage points per quarter (p = 0.005) in access to low-mortality hospitals after Medicaid expansion.CONCLUSIONS: Pre-Affordable Care Act 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. (C) 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.