Adrian Diaz1,2,3, Daniel Chavarin4, Anghela Z Paredes4, Timothy M Pawlik5. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 3. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. 4. College of Medicine, Ohio State University, Columbus, OH, USA. 5. College of Medicine, Ohio State University, Columbus, OH, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: A primary goal of the recent state and federal health reform is to increase access to care through expanded insurance coverage. We sought to evaluate the effect of Medicaid expansion (ME) on four high-risk cancer operations in California. METHODS: The California Office of Statewide Health Planning database was used to identify patients who underwent either lung, esophageal, pancreas, or rectal resection for cancer between 2012 and 2016. To include only patients eligible for Medicaid and not Medicare, patients > 65 years were excluded. Trends in insurance coverage rates and utilization of high-volume hospitals were evaluated relative to the pre-policy (2012-2013) versus the post-policy (2014-2016) period. RESULTS: Overall 10,569 individuals (esophageal: 5.6%; lung: 38%; pancreas: 14.1%; rectal: 42.3%) underwent a cancer operation. Following ME, Medicaid coverage increased from 12.4 to 20.2% (p < 0.001). There were no differences in age, sex, and race of Medicare beneficiaries pre- versus post-policy implementation (all p > 0.05). Of note, following ME, there was an increase in probability of utilization of high-volume hospitals for lung (47.6% vs. 56.3%), rectal (74.0% vs. 77.7%), and pancreas (60.2% vs. 68.5%) (p < 0.05 for all) cancer operations. Overall probability of surgery at a high-volume center after expansion increased by 5.8% among Medicaid beneficiaries versus other patients in the same time period. ME was not associated, however, with improvement in clinical outcomes such as complications, in-hospital mortality, or readmission (all p > 0.05). CONCLUSION: ME was associated with an increase in Medicaid coverage, which resulted in more beneficiaries undergoing cancer operations at high-volume hospitals. While ME was associated with increased access to care, peri-operative outcomes were comparable pre- versus post-ME implementation.
INTRODUCTION: A primary goal of the recent state and federal health reform is to increase access to care through expanded insurance coverage. We sought to evaluate the effect of Medicaid expansion (ME) on four high-risk cancer operations in California. METHODS: The California Office of Statewide Health Planning database was used to identify patients who underwent either lung, esophageal, pancreas, or rectal resection for cancer between 2012 and 2016. To include only patients eligible for Medicaid and not Medicare, patients > 65 years were excluded. Trends in insurance coverage rates and utilization of high-volume hospitals were evaluated relative to the pre-policy (2012-2013) versus the post-policy (2014-2016) period. RESULTS: Overall 10,569 individuals (esophageal: 5.6%; lung: 38%; pancreas: 14.1%; rectal: 42.3%) underwent a cancer operation. Following ME, Medicaid coverage increased from 12.4 to 20.2% (p < 0.001). There were no differences in age, sex, and race of Medicare beneficiaries pre- versus post-policy implementation (all p > 0.05). Of note, following ME, there was an increase in probability of utilization of high-volume hospitals for lung (47.6% vs. 56.3%), rectal (74.0% vs. 77.7%), and pancreas (60.2% vs. 68.5%) (p < 0.05 for all) cancer operations. Overall probability of surgery at a high-volume center after expansion increased by 5.8% among Medicaid beneficiaries versus other patients in the same time period. ME was not associated, however, with improvement in clinical outcomes such as complications, in-hospital mortality, or readmission (all p > 0.05). CONCLUSION:ME was associated with an increase in Medicaid coverage, which resulted in more beneficiaries undergoing cancer operations at high-volume hospitals. While ME was associated with increased access to care, peri-operative outcomes were comparable pre- versus post-ME implementation.
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