Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
Department of Health Systems, Management, and Policy, University of Colorado Cancer Center, University of Colorado, Aurora, Colorado.
Cancer. 2017 Sep 1;123(17):3312-3319. doi: 10.1002/cncr.30771. Epub 2017 Jun 26.
States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women.
The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment. The study outcomes were changes in stage of disease at the time of diagnosis and delays in treatment of >60 days and >90 days.
Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment. Disenrollment was found to be associated with a 3.3-percentage point increase in late stage of disease at the time of diagnosis (P = .024), a 1.9-percentage point decrease in having a delay of >60 days in surgery (P = .024), and a 1.4-percentage point decrease in having a delay of >90 days in treatment (P = .054) for women living in low-income zip codes compared with women residing in high-income zip codes.
The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society.
各州为应对全州经济状况，通常会考虑缩减医疗补助计划（Medicaid）的覆盖范围。据作者所知，对于公共保险范围缩小对健康结果的影响，人们知之甚少。本研究调查了 2005 年田纳西州医疗补助计划退保对非老年女性乳腺癌诊断时的分期和治疗延迟的影响。
作者使用了 2002 年至 2008 年田纳西州癌症登记处的数据，并使用差异中的差异模型（difference-in-difference model）比较了居住在低收入邮政编码地区（因此更有可能被退保）的乳腺癌患者和居住在高收入邮政编码地区的类似患者，比较了这些患者在 2005 年医疗补助计划退保前后的诊断时疾病分期的变化和治疗时间超过 60 天和 90 天的延迟情况。
总的来说，田纳西州的非老年女性被诊断为疾病晚期的比例更高，并且在退保后治疗延迟的情况更多。退保被发现与诊断时晚期疾病的比例增加了 3.3 个百分点（P =.024）、手术延迟 60 天以上的比例降低了 1.9 个百分点（P =.024）以及治疗延迟 90 天以上的比例降低了 1.4 个百分点（P =.054）相关，对于居住在低收入邮政编码地区的女性而言，这一比例与居住在高收入邮政编码地区的女性相比。
本研究的结果表明，医疗补助计划退保与乳腺癌诊断时的疾病晚期有关，从而为医疗补助计划缩小范围可能对健康产生的负面影响提供了证据。癌症 2017；123:3312-9。©2017 美国癌症协会。
