Halpern Michael T, Schrag Deborah
RTI International, Washington, DC, USA.
Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave. # 533, Philadelphia, PA, 19122, USA.
Breast Cancer Res Treat. 2016 Aug;158(3):573-81. doi: 10.1007/s10549-016-3879-8. Epub 2016 Jul 15.
Medicaid beneficiaries with cancer are less likely to receive timely and high-quality care. This study examined whether differences in state-level Medicaid policies affect delays in time to surgery (TTS) among women diagnosed with breast cancer. Using 2006-2008 Medicaid data, we identified women aged 18-64 enrolled in Medicaid diagnosed with breast cancer. Analyses examined associations of state-specific Medicaid surgery reimbursements, Medicaid eligibility recertification period (annually vs. shorter) and required patient copayment on time from breast cancer diagnosis to receipt of breast surgery. Patients receiving neoadjuvant therapy were excluded. Separate multivariable regression analyses controlling for patient demographic characteristics and clustering by state were performed for breast conserving surgery (BCS), inpatient mastectomy, and outpatient mastectomy. The study included 7542 Medicaid beneficiaries with breast cancer: 3272 received BCS, 2156 outpatient mastectomy, and 2115 inpatient mastectomy. Higher Medicaid reimbursements for BCS were associated with decreased time from diagnosis to surgery. A 12-month (vs. <12 month) Medicaid eligibility recertification period was associated with decreased TTS for BCS and outpatient mastectomy. Black Medicaid beneficiaries (compared with non-Hispanic White beneficiaries) were more likely to experience delays for all three types of surgery, while Hispanic beneficiaries were more likely to experience delays only for outpatient mastectomy. State-level Medicaid policies and patient characteristics can affect receipt of timely surgery among Medicaid beneficiaries with breast cancer. As delays in surgery can increase morbidity and mortality, changes to state Medicaid policies and health system programs are needed to improve access to care for this vulnerable population.
患有癌症的医疗补助受益人群不太可能获得及时且高质量的护理。本研究调查了州级医疗补助政策的差异是否会影响被诊断为乳腺癌的女性患者手术延迟时间（TTS）。利用2006 - 2008年医疗补助数据，我们确定了年龄在18 - 64岁、参加医疗补助且被诊断为乳腺癌的女性。分析研究了特定州的医疗补助手术报销、医疗补助资格重新认证期限（每年与更短期限）以及从乳腺癌诊断到接受乳房手术所需患者自付费用之间的关联。接受新辅助治疗的患者被排除在外。针对保乳手术（BCS）、住院乳房切除术和门诊乳房切除术，分别进行了控制患者人口统计学特征并按州聚类的多变量回归分析。该研究纳入了7542名患有乳腺癌的医疗补助受益人群：3272人接受了保乳手术，2156人接受了门诊乳房切除术，2115人接受了住院乳房切除术。保乳手术的医疗补助报销金额越高，从诊断到手术的时间越短。12个月（对比<12个月）的医疗补助资格重新认证期限与保乳手术和门诊乳房切除术的手术延迟时间缩短有关。黑人医疗补助受益人群（与非西班牙裔白人受益人群相比）在所有三种手术类型中更有可能经历延迟，而西班牙裔受益人群仅在门诊乳房切除术中更有可能经历延迟。州级医疗补助政策和患者特征会影响患有乳腺癌的医疗补助受益人群及时接受手术的情况。由于手术延迟会增加发病率和死亡率，因此需要改变州医疗补助政策和卫生系统项目，以改善这一弱势群体获得医疗服务的机会。
