Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries.
Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries.
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DOI：
10.1097/sla.0000000000002952
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发表时间：
2018-10
影响因子：
9
通讯作者：
Kuo PC
中科院分区：
文献类型：
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作者：
Eguia E;Cobb AN;Kothari AN;Molefe A;Afshar M;Aranha GV;Kuo PC
本研究旨在评估平价医疗法案（ACA）医疗补助扩张后癌症（CA）入院和手术的趋势。这是一项使用HCUP-SID分析住院CA（胰腺、食管、肺、膀胱、乳腺、结直肠、前列腺和胃）入院和手术前（2010-2013）和后（2014）医疗补助扩展的回顾性研究。手术定义为观察到的每100例癌症住院患者的切除率。比较了非扩张状态（FL）和扩张状态（IA、MD和NY）。广义线性模型采用Poisson分布和Logistic回归，并采用发病率比（IRR）和差异-无差异（DID）。我们的样本中有317858名患者，包括有私人保险、医疗补助或没有保险的患者。胰腺、乳腺、结直肠、前列腺和胃CA的入院率在扩张状态下显著增加，但在非扩张状态下下降。(IRR 1.12，1.14，1.11，1.34，1.23; P <0.05）在扩张状态下，肺和结直肠CA手术（IRR 1.30，1.25; P <0.05）增加，而乳腺CA手术（IRR 1.25; P <0.05）减少较少。在改革后的扩张状态下，政府补贴或自费患者接受肺部、膀胱和结直肠CA手术的几率更大（OR 0.45 vs 0.33;0.60 vs 0.48; 0.47 vs 0.39; P <0.05）。在ACA下扩大医疗补助覆盖范围的州，结直肠癌和肺癌的手术率显着增加，而乳腺癌手术减少较少。附带说明，这些癌症受人口筛查计划的影响。我们的结论是，扩大保险覆盖范围的结果，提高获得癌症手术。
This study aims to evaluate the trends in cancer (CA) admissions and surgeries after the Affordable Care Act (ACA) Medicaid expansion. This is a retrospective study using HCUP-SID analyzing inpatient CA (pancreas, esophagus, lung, bladder, breast, colorectal, prostate, and gastric) admissions and surgeries pre- (2010–2013) and post- (2014) Medicaid expansion. Surgery was defined as observed resection rate per 100 cancer admissions. Nonexpansion (FL) and expansion states (IA, MD, and NY) were compared. A generalized linear model with a Poisson distribution and logistic regression was used with incidence rate ratios (IRR) and difference-indifferences (DID). There were 317, 858 patients in our sample which included those with private insurance, Medicaid, or no insurance. Pancreas, breast, colorectal, prostate, and gastric CA admissions significantly increased in expansion states but decreased in nonexpansion states. (IRR 1.12, 1.14, 1.11, 1.34, 1.23; P <.05) Lung and colorectal CA surgeries (IRR 1.30, 1.25; P <.05) increased, while breast CA surgeries (IRR 1.25; P <.05) decreased less in expansion states. Government subsidized, or self-pay patients had greater odds of undergoing lung, bladder, and colorectal CA surgery (OR 0.45 vs 0.33;0.60 vs 0.48; 0.47 vs 0.39; P <.05) in expansion states after reform. In states that expanded Medicaid coverage under the ACA, the rate of surgeries for colorectal and lung CA increased significantly, while breast CA surgeries decreased less. Parenthetically, these cancers are subject to population screening programs. We conclude that expanding insurance coverage results in enhanced access to cancer surgery.