Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations
- 1 January 2018
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Oncology Practice
- Vol. 14 (1), e42-e50
- https://doi.org/10.1200/jop.2017.025684
Abstract
Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals (P < .001). The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.Keywords
This publication has 27 references indexed in Scilit:
- Disparities in access to care at high‐volume institutions for uro‐oncologic proceduresCancer, 2012
- Trends in Hospital Volume and Operative Mortality for High-Risk SurgeryThe New England Journal of Medicine, 2011
- Variations in Referral Patterns to High-Volume Centers for Pancreatic CancerJournal of the American College of Surgeons, 2009
- Centralization of Cancer Surgery: Implications for Patient Access to Optimal CareJournal of Clinical Oncology, 2009
- The impact of socioeconomic status on survival after cancer in the United StatesCancer, 2008
- Association of Insurance with Cancer Care Utilization and OutcomesCA: A Cancer Journal for Clinicians, 2008
- Inference with Difference-in-Differences and Other Panel DataThe Review of Economics and Statistics, 2007
- Long-Term Survival Is Superior After Resection for Cancer in High-Volume CentersAnnals of Surgery, 2005
- Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly PatientsJournal of Clinical Oncology, 2005
- The Influence of Hospital Volume on Survival after Resection for Lung CancerThe New England Journal of Medicine, 2001