Pasalic Dario, Jiang Jing, Jagsi Reshma, Giordano Sharon H, Smith Benjamin D
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Tex.; Department of Radiation Oncology, The University of Michigan, Ann Arbor, Mich.; and Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Plast Reconstr Surg Glob Open. 2017 Jul 26;5(7):e1360. doi: 10.1097/GOX.0000000000001360. eCollection 2017 Jul.
Our group sought to determine the influence of health insurance coverage on use of immediate breast reconstruction for working-age women undergoing mastectomy for breast cancer.
We used 2 complementary databases, the Texas Cancer Registry-linked Medicaid database and the MarketScan private insurance database, to identify working-age women in Texas from 2000 to 2007 treated with mastectomy for incident breast cancer. Logistic regression tested the association between Medicaid versus private insurance and receipt of immediate breast reconstruction, adjusting for patient, treatment, and socio-demographic covariates. Reimbursement for reconstruction, adjusted for inflation and reported in 2014 dollars, was estimated from claims.
Median age was 49.7 years for the Medicaid cohort compared with 50.4 years for the MarketScan cohort ( = 0.02). From 2000 to 2007, use of reconstruction increased significantly for patients in the MarketScan cohort (38.1-53.9%; = 0.009) but not those in the Medicaid cohort (10.5-16.6%; = 0.24). In total, 15.7% of patients in the Medicaid cohort underwent immediate reconstruction (n = 213/1,360) compared with 50.7% (n = 1,405/2,772) of patients in the MarketScan cohort (adjusted relative risk, 3.09; 95% CI, 2.78-3.40). Reimbursement for reconstruction was $3,167 (95% CI, $2,512-$3,820) for patients in the Medicaid cohort compared with $15,432 (95% CI, $14,030-$16,834) for patients in the MarketScan cohort.
Type of insurance coverage is an important factor associated with receipt of immediate breast reconstruction. We postulate that the marked difference in reimbursement for reconstruction between Medicaid and private insurance creates a relative disincentive for plastic surgeons and hospitals to offer breast reconstruction to patients with Medicaid.
我们的研究小组试图确定医疗保险覆盖范围对因乳腺癌接受乳房切除术的适龄女性进行即刻乳房重建手术的影响。
我们使用了两个互补的数据库，即与德克萨斯癌症登记处相关联的医疗补助数据库和市场扫描私人保险数据库，以识别2000年至2007年在德克萨斯州因原发性乳腺癌接受乳房切除术的适龄女性。逻辑回归分析检验了医疗补助保险与私人保险以及即刻乳房重建手术接受情况之间的关联，并对患者、治疗和社会人口统计学协变量进行了调整。根据索赔估算了经通胀调整并以2014年美元计算的重建费用。
医疗补助队列的中位年龄为49.7岁，而市场扫描队列的中位年龄为50.4岁（P = 0.02）。从2000年到2007年，市场扫描队列中患者的重建手术使用率显著增加（从38.1%增至53.9%；P = 0.009），但医疗补助队列中的患者未出现显著增加（从10.5%增至16.6%；P = 0.24）。总体而言，医疗补助队列中有15.7%的患者接受了即刻重建手术（n = 213/1360），而市场扫描队列中有50.7%的患者接受了即刻重建手术（n = 1405/2772）（调整后的相对风险为3.09；95%置信区间为2.78 - 3.40）。医疗补助队列中患者的重建费用为3167美元（95%置信区间为2512 - 3820美元），而市场扫描队列中患者的重建费用为15432美元（95%置信区间为14030 - 16834美元）。
保险覆盖类型是与接受即刻乳房重建手术相关的一个重要因素。我们推测，医疗补助保险和私人保险在重建费用报销方面的显著差异，使得整形外科医生和医院为医疗补助患者提供乳房重建手术的积极性相对降低。
