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

项目总结/摘要 癌症是美国最常见的死亡原因和最昂贵的疾病之一， 高质量的治疗对减少癌症发病率和死亡率至关重要。保险范围是 这是获得护理的重要决定因素，导致记录在案的结果差异。的 《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。 市场覆盖率和医疗补助计划的扩大，以低收入成年人在参与国。几乎没有 关于保险覆盖范围扩大对癌症护理的获得或质量的影响的证据。的 拟议的项目将利用ACA条款的时间变化和这些条款覆盖范围的变化， 跨地理区域的规定，以估计保险覆盖范围扩大对癌症的影响 治疗我们使用了宾夕法尼亚州的人口数据，宾夕法尼亚州是医疗补助扩张最大的州， 在ACA之前，没有广泛覆盖低收入成年人。数据来自宾夕法尼亚州- 广泛的癌症登记处，沿着来自所有付费住院患者、医院门诊患者和门诊手术的数据 宾夕法尼亚州卫生保健成本控制理事会（PHC 4）的中心行政文件，链接到 在个人层面上的注册。样本包括该州所有非老年成年癌症患者， 所有付款人的出院信息，包括未投保的患者。我们使用一种准实验性的 评估私人（市场）和公共（医疗补助）扩张对获得 和护理质量的患者诊断为四种最常见的癌症（乳腺癌，前列腺癌，肺癌和乳腺癌）， 结肠直肠）。具体而言，我们研究了保险扩张对癌症保险覆盖范围的影响 患者（目标1）、获得癌症治疗（目标2）和癌症护理质量（目标3）。我们假设 覆盖率的增加将与从诊断到治疗的时间缩短有关; 在经认可的癌症中心、学术中心和高容量医院接受治疗; 指导一致的护理;减少再入院。所有分析将按癌症类型分层， 允许评估不同癌症的不同影响，我们将评估保险的作用， 在减少种族/族裔少数群体和农村人口在获得服务方面的差距方面，该项目将 提供详细证据，说明ACA如何影响癌症的保险范围、获得和护理质量 患者，包括对服务不足的种族/族裔少数群体和农村 患者详细了解医疗保险覆盖范围扩大对癌症护理的影响 （美国最昂贵和最致命的疾病之一）将告知联邦和州政策制定者辩论 卫生改革建议，规划官员寻求证据，以指导发展和实施， 覆盖和护理提供政策，研究人员评估正在进行的政策变化和干预措施， 减少癌症治疗的差距。

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.