Ramachandran Vignesh, Park Katherine E, Shah Jesal R, Duvic Madeleine
Baylor College of Medicine, Houston, Texas, USA The University of Texas MD Anderson Cancer Center, Houston, TX.
Dermatol Online J. 2019 Nov 15;25(11):13030/qt5n4481mk.
The Affordable Care Act (ACT) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes.
《平价医疗法案》（ACA）的实施旨在增加医疗保健服务的可及性，并减少儿童与医疗保险覆盖人群之间年龄段（18 - 64岁）的未参保人数。ACA与诊断时的保险类型（未参保、医疗补助、非医疗补助）之间的关联已在耳鼻喉科、妇科以及五大非皮肤恶性肿瘤方面展开研究。然而，针对皮肤恶性肿瘤的此类研究尚属空白。我们对美国国立癌症研究所前瞻性的监测、流行病学和最终结果（SEER）癌症数据库进行了回顾性分析，以评估ACA对按保险类型划分的皮肤T细胞淋巴瘤（CTCL）新诊断病例的影响。与先前对其他恶性肿瘤的研究不同，在所有州、扩大医保覆盖范围的州和未扩大医保覆盖范围的州全面实施ACA前后，我们并未观察到按保险类型划分的CTCL诊断率存在显著差异。皮肤癌没有筛查指南，且CTCL是一种罕见的恶性肿瘤，这两者可能是导致这些结果的原因。然而，与未扩大医保覆盖范围的州相比，扩大医保覆盖范围的州在降低新诊断的CTCL未参保患者比例方面要接近得多。因此，审慎的做法可能是调查医疗补助患者在医疗保健方面存在的内在社会经济障碍，以改善他们获得医疗服务的机会，从而减少未参保人群并改善治疗结果。
