Emanuel Eguia1, Marshall S Baker2, Bipan Chand2, Patrick J Sweigert2, Paul C Kuo3. 1. Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: emanuel.eguia@lumc.edu. 2. Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. 3. Department of Surgery, University of South Florida, Tampa, FL, USA.
Abstract
INTRODUCTION: This study aims to evaluate the effect of the ACA Medicaid expansion on the utilization of minimally invasive (MIS) approaches to common general surgical procedures. METHODS: We queried five Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates of utilization and costs of MIS and open approaches pre and post Medicaid expansion. RESULTS: 117,241 patients met the inclusion criteria. Following the enactment of the ACA, use of both laparoscopic gastric bypass (IRR 1.08; 95% CI: [1.02, 1.15]) and Nissen fundoplication (IRR 1.17; 95% CI [1.09, 1.26]) increased in Medicaid patients treated in expansion states than in those treated in non-expansion states. Simultaneously, the costs reported for self-pay patients increased in expansion states more than in non-expansion states (+$1669; 95% CI [$655, $2682]). CONCLUSIONS: Medicaid expansion was associated with increased rates of utilization of MIS approaches to several surgical procedures and a shifting of costs toward patients who were self-insured.
INTRODUCTION: This study aims to evaluate the effect of the ACA Medicaid expansion on the utilization of minimally invasive (MIS) approaches to common general surgical procedures. METHODS: We queried five Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates of utilization and costs of MIS and open approaches pre and post Medicaid expansion. RESULTS: 117,241 patients met the inclusion criteria. Following the enactment of the ACA, use of both laparoscopic gastric bypass (IRR 1.08; 95% CI: [1.02, 1.15]) and Nissen fundoplication (IRR 1.17; 95% CI [1.09, 1.26]) increased in Medicaid patients treated in expansion states than in those treated in non-expansion states. Simultaneously, the costs reported for self-pay patients increased in expansion states more than in non-expansion states (+$1669; 95% CI [$655, $2682]). CONCLUSIONS: Medicaid expansion was associated with increased rates of utilization of MIS approaches to several surgical procedures and a shifting of costs toward patients who were self-insured.
Authors: Andrew P. Loehrer; David C. Chang; John W. Scott; Matthew M. Hutter; Virendra I. Patel; Jeffrey E. Lee; Benjamin D. Sommers Journal: JAMA Surg Date: 2018-03-01 Impact factor: 14.766
Authors: Brett L Ecker; Lindsay E Y Kuo; Kristina D Simmons; John P Fischer; Jon B Morris; Rachel R Kelz Journal: Surg Endosc Date: 2015-06-20 Impact factor: 4.584
Authors: Armando Rosales-Velderrain; Steven P Bowers; Ross F Goldberg; Tatyan M Clarke; Mauricia A Buchanan; John A Stauffer; Horacio J Asbun Journal: World J Gastroenterol Date: 2012-08-28 Impact factor: 5.742
Authors: Ralph Peterli; Bettina Karin Wölnerhanssen; Thomas Peters; Diana Vetter; Dino Kröll; Yves Borbély; Bernd Schultes; Christoph Beglinger; Jürgen Drewe; Marc Schiesser; Philipp Nett; Marco Bueter Journal: JAMA Date: 2018-01-16 Impact factor: 56.272
Authors: Corey J Lager; Nazanene H Esfandiari; Angela R Subauste; Andrew T Kraftson; Morton B Brown; Ruth B Cassidy; Catherine K Nay; Amy L Lockwood; Oliver A Varban; Elif A Oral Journal: Obes Surg Date: 2017-01 Impact factor: 4.129
Authors: Erik J DeAngelis; James A Zebley; Ikechukwu S Ileka; Sangrag Ganguli; Armon Panahi; Richard L Amdur; Khashayar Vaziri; Juliet Lee; Hope T Jackson Journal: Surg Endosc Date: 2022-06-22 Impact factor: 4.584