Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations
Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations
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DOI：
10.1200/jop.2017.025684
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Chang, George J.
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文献类型：
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作者：
Loehrer, Andrew P.;Chang, David C.;Chang, George J.
目的保险不足的患者不太可能在手术量大的医院接受复杂的癌症手术(大容量医院，或称HVH)，这导致护理方面的差异。到目前为止，保险覆盖范围扩大对复杂癌症手术地点的影响尚不清楚。方法以2006年马萨诸塞州保险覆盖范围扩大为自然实验，我们搜索了2001年至2011年马萨诸塞州和对照州(纽约州、新泽西州和佛罗里达州)的医院成本和利用项目住院患者数据库，以评估扩大保险覆盖范围后膀胱癌、食道癌、胃癌、胰腺癌、直肠癌和肺癌切除手术中使用高压医疗设备的变化。我们研究了非老年、有私人保险的成人患者和那些有政府补贴或自付(GSSP)保险的患者。结果我们研究了马萨诸塞州的11,687名患者和对照组的56,300名患者。与对照州相比，2006年马萨诸塞州的保险扩大与GSSP患者的手术干预率增加了14%相关(发生率比率为1.14；P=.015)，但GSSP患者在高压下接受手术的概率没有显著变化(增加了1.0个百分点；P=.710)。这项改革与卫生保健机构未参保的付费比例没有变化(0.6个百分点；P=.244)和低流量医院的未参保付费比例下降5.1个百分点(P<；.001)有关。结论2006年马萨诸塞州的保险扩张是《平价医疗法案》的典范，它与复杂癌症手术的费率增加和保险覆盖范围的扩大有关，但对复杂癌症手术的高压医疗的使用率没有变化。
PurposeUnderinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown.MethodsUsing the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework.ResultsWe studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals (P < .001).ConclusionThe 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.