Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High-Quality Hospitals
Open Access
- 5 October 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 226 (1), 22-29
- https://doi.org/10.1016/j.jamcollsurg.2017.09.012
Abstract
The Affordable Care Act's Medicaid expansion has been heavily debated due to skepticism about Medicaid's ability to provide high-quality care. Particularly, little is known about whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in the pre-Affordable Care Act era, on this disparity measure. We identified 67,685 nonelderly adults from the New York State Inpatient Database who underwent select cancer resections. High-quality hospitals were defined as high-volume or low-mortality hospitals. Disparity was defined as model-adjusted difference in percentage of patients receiving operations at high-quality hospitals by insurance type (Medicaid/uninsured vs privately insured) or by race (African American vs white). Levels of disparity were calculated quarterly for each comparison pair and then analyzed using interrupted time series to evaluate the impact of Medicaid expansion. Disparity in access to high-volume hospitals by insurance type was reduced by 0.97 percentage points per quarter after Medicaid expansion (p < 0.0001). Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured; no significant change was detected around expansion. Conversely, racial disparity increased by 0.87 percentage points per quarter (p < 0.0001) in access to high-volume hospitals and by 0.48 percentage points per quarter (p = 0.005) in access to low-mortality hospitals after Medicaid expansion. Pre-Affordable Care Act Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with increased racial disparity in access to high-quality hospitals. Addressing racial barriers in access to high-quality hospitals should be prioritized.Keywords
This publication has 31 references indexed in Scilit:
- The Oregon Experiment — Effects of Medicaid on Clinical OutcomesThe New England Journal of Medicine, 2013
- Disparities in access to care at high‐volume institutions for uro‐oncologic proceduresCancer, 2012
- Who Receives Their Complex Cancer Surgery at Low-Volume Hospitals?Journal of the American College of Surgeons, 2012
- Variability in the Measurement of Hospital-wide Mortality RatesThe New England Journal of Medicine, 2010
- Understanding Racial Disparities in Cancer Treatment and OutcomesJournal of the American College of Surgeons, 2010
- Trends in Centralization of Cancer SurgeryAnnals of Surgical Oncology, 2010
- Hospital Volume and Late Survival After Cancer SurgeryAnnals of Surgery, 2007
- Evaluation of the Causes for Racial Disparity in Surgical Treatment of Early Stage Lung CancerSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- Primary Care Physicians Who Treat Blacks and WhitesThe New England Journal of Medicine, 2004
- Hospital Volume and Surgical Mortality in the United StatesThe New England Journal of Medicine, 2002