Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform

保险范围扩大对癌症治疗的影响：最近的政策变化以及对未来改革的影响

• 批准号: 10116048
• 负责人: Lindsay Marie Sabik
• 金额: $ 39.65万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10116048
• 关键词: Effects; Insurance; Expansions; Cancer; Treatment

PROJECT SUMMARY/ABSTRACT Cancer is among the most common causes of death and most costly diseases in the US, and timely access to high quality treatment is essential for minimizing cancer morbidity and mortality. Insurance coverage is an important determinant of access to care that contributes to documented disparities in outcomes. The Affordable Care Act (ACA) expanded access to insurance for non-elderly adults through subsidized Marketplace coverage and expansion of Medicaid to low-income adults in participating states. There is little evidence regarding the impact of insurance coverage expansions on access to or quality of cancer care. The proposed project will leverage variation in the timing of ACA provisions and changes in coverage under those provisions across geographic areas to estimate the impacts of insurance coverage expansions on cancer treatment. We use population-based data from Pennsylvania – the largest Medicaid expansion state that did not have extensive coverage for low-income adults prior to the ACA. Data come from the Pennsylvania state- wide cancer registry, along with data from all-payer inpatient, hospital outpatient, and ambulatory surgery center administrative files from the Pennsylvania Health Care Cost Containment Council (PHC4), linked to the registry at the individual level. The sample includes all non-elderly adult cancer patients in the state, with discharge information across all payers, including for uninsured patients. We use a quasi-experimental approach to estimate the effects of both private (Marketplace) and public (Medicaid) expansions on access to and quality of care for patients diagnosed with the four most common cancers (breast, prostate, lung and colorectal). Specifically, we examine the impact of insurance expansions on insurance coverage for cancer patients (Aim 1), access to cancer treatment (Aim 2), and quality of cancer care (Aim 3). We hypothesize that increases in coverage will be associated with shorter time from diagnosis to treatment; higher likelihood of treatment in accredited cancer centers, academic centers, and high-volume hospitals; increased receipt of guideline concordant care; and reductions in hospital readmission. All analysis will be stratified by cancer type, allowing for assessment of differential impacts across cancers, and we will assess the role of insurance coverage in reducing disparities in access for racial/ethnic minorities and rural populations. The project will provide detailed evidence on how the ACA affected insurance coverage, access, and quality of care for cancer patients, including the impact on existing disparities in care for underserved racial/ethnic minority and rural patients. A detailed understanding of the impacts of health insurance coverage expansions on care for cancer (among the most costly and deadly diseases in the US) will inform federal and state policymakers debating health reform proposals, program officials seeking evidence to guide development and implementation of coverage and care delivery policies, and researchers assessing ongoing policy changes and interventions to reduce disparities in cancer care.

项目概要/摘要 癌症是美国最常见的死亡原因和最昂贵的疾病之一，及时获得 高质量的治疗对于最大限度地减少癌症发病率和死亡率至关重要。保险范围是 获得护理的重要决定因素，导致记录结果存在差异。这 《平价医疗法案》(ACA) 通过补贴扩大了非老年人获得保险的机会 医疗补助的市场覆盖范围和扩大到参与州的低收入成年人。很少有 有关保险覆盖范围扩大对癌症护理的获取或质量影响的证据。这 拟议项目将利用《平价医疗法案》条款的时间变化以及这些条款覆盖范围的变化 跨地理区域的规定来估计保险覆盖范围扩大对癌症的影响 治疗。我们使用来自宾夕法尼亚州的基于人口的数据 - 最大的医疗补助扩张州 在 ACA 之前，尚未对低收入成年人提供广泛的保险。数据来自宾夕法尼亚州—— 广泛的癌症登记，以及来自全付费住院患者、医院门诊患者和门诊手术的数据 来自宾夕法尼亚州医疗保健成本控制委员会 (PHC4) 的中心行政文件，链接到 个人层面的登记。该样本包括该州所有非老年成年癌症患者，其中 所有付款人的出院信息，包括未参保患者的出院信息。我们使用准实验 估计私人（市场）和公共（医疗补助）扩张对获得医疗服务的影响的方法 被诊断患有四种最常见癌症（乳腺癌、前列腺癌、肺癌和 结直肠）。具体来说，我们研究了保险范围扩大对癌症保险覆盖范围的影响 患者（目标 1）、获得癌症治疗的机会（目标 2）以及癌症护理的质量（目标 3）。我们假设 覆盖范围的增加将导致从诊断到治疗的时间缩短；更高的可能性 在认可的癌症中心、学术中心和大容量医院进行治疗；增加收据 指导一致护理；并减少再入院率。所有分析都将按癌症类型进行分层， 允许评估不同癌症的不同影响，我们将评估保险的作用 减少少数种族/族裔和农村人口获取机会方面的差距。该项目将 提供有关 ACA 如何影响癌症保险覆盖范围、获取机会和护理质量的详细证据 患者，包括对服务不足的少数族裔和农村地区现有护理差异的影响 患者。详细了解健康保险覆盖范围扩大对癌症护理的影响 （美国最昂贵和致命的疾病之一）将告知联邦和州政策制定者的辩论 卫生改革提案、计划官员寻求证据来指导制定和实施 覆盖范围和护理服务政策，以及研究人员评估持续的政策变化和干预措施 减少癌症护理方面的差异。