Loehrer Andrew P, Song Zirui, Haynes Alex B, Chang David C, Hutter Matthew M, Mullen John T
All authors: Massachusetts General Hospital, Boston, MA.
J Clin Oncol. 2016 Dec;34(34):4110-4115. doi: 10.1200/JCO.2016.68.5701. Epub 2016 Oct 31.
Purpose Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. Methods We used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. Results Before the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P < .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, -11.88 to -0.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. Conclusion The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.
结直肠癌是美国第三大常见癌症及癌症死亡的第三大主要原因。缺乏保险覆盖与就诊时疾病更晚期、结肠切除时更紧急的入院情况以及相对于有私人保险的患者生存率较低有关。2006年马萨诸塞州的医疗保健改革是一项独特的自然实验，用于评估保险范围扩大对结直肠癌治疗的影响。方法：我们使用医院成本与利用项目州住院数据库，确定2001年至2011年期间在马萨诸塞州（n = 17,499）和三个对照州（n = 144,253）住院的有政府补贴或自费（GSSP）或私人保险的结直肠癌患者。差异-差异模型评估了2006年马萨诸塞州保险范围扩大对结直肠癌切除的影响，同时控制混杂因素和长期趋势。结果：在2006年马萨诸塞州改革之前，在马萨诸塞州和对照州，政府补贴或自费患者的结直肠癌切除率均显著低于有私人保险的患者。与对照州相比，马萨诸塞州的保险范围扩大与切除率提高44%（率比 = 1.44；95%CI，1.23至1.68；P <.001）、紧急入院概率降低6.21个百分点（95%CI，-11.88至-0.54；P =.032）以及择期入院概率提高8.13个百分点（95%CI，1.34至14.91；P =.019）相关。结论：2006年马萨诸塞州的医疗保健改革作为《平价医疗法案》的一个范例，与结直肠癌切除率提高和紧急切除概率降低有关。我们的研究结果表明，保险范围扩大可能有助于改善结直肠癌患者获得治疗的机会。
