Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Am Coll Surg. 2021 Feb;232(2):146-156.e1. doi: 10.1016/j.jamcollsurg.2020.10.021. Epub 2020 Nov 23.
The Affordable Care Act facilitated improved insurance coverage for states that expanded Medicaid coverage, but the impact on cancer outcomes is unclear. This study compared changes in the diagnosis and management of colon cancer in states that did and did not participate in Medicaid expansion.
Using a quasi-experimental difference-in-differences (DID) approach, we analyzed Medicaid and uninsured patients in the National Cancer Data Base during 2 time periods: pre (2011-2012) and post expansion (2015-2016). Patients in non-expansion states were compared with those in January 2014 expansion states with regard to changes in patient and facility characteristics, cancer staging, treatment decisions, and surgical outcomes.
Along with increased Medicaid coverage (DID = 20.27; p < 0.001), patients in expansion states had an increase in stage I diagnoses (DID = 2.97; p = 0.035), distance traveled (miles, DID = 6.67; p = 0.005), and treatment at integrated network programs (DID = 2.67; p = 0.045). More early-stage patients were treated within 30 days (DID = 7.24; p = 0.035) and more stage IV patients received palliative care (DID = 5.01; p = 0.048). Among surgical patients, Medicaid expansion correlated with fewer urgent cases (< 7 days, DID = -5.88; p = 0.008) and more minimally invasive surgery (DID = 5.00; p = 0.022). There were no observed differences in postoperative outcomes or adjuvant chemotherapy.
Medicaid expansion correlated with earlier diagnosis, enhanced access, and improved surgical care for colon cancer patients. These findings highlight the importance of improving health insurance coverage and can help guide future policy efforts.
平价医疗法案促进了扩大医疗补助覆盖范围的各州的保险覆盖范围的改善，但对癌症结果的影响尚不清楚。本研究比较了参与和不参与医疗补助扩大计划的州的结肠癌诊断和治疗的变化。
使用准实验性差异-差异（DID）方法，我们分析了国家癌症数据库中在两个时期内的医疗补助和无保险患者：前（2011-2012）和后扩大（2015-2016）。与非扩张州的患者相比，2014 年 1 月扩张州的患者在患者和医疗机构特征、癌症分期、治疗决策和手术结果方面的变化。
随着医疗补助覆盖范围的增加（DID=20.27；p<0.001），扩张州的患者Ⅰ期诊断增加（DID=2.97；p=0.035），距离增加（英里，DID=6.67；p=0.005），并且在综合网络计划中接受治疗（DID=2.67；p=0.045）。更多的早期患者在 30 天内接受治疗（DID=7.24；p=0.035），更多的 IV 期患者接受姑息治疗（DID=5.01；p=0.048）。在手术患者中，医疗补助的扩大与更少的紧急情况（<7 天，DID=-5.88；p=0.008）和更多的微创手术（DID=5.00；p=0.022）相关。术后结果或辅助化疗没有观察到差异。
医疗补助的扩大与结肠癌患者的早期诊断、增强的治疗机会和改善的手术护理相关。这些发现强调了改善健康保险覆盖范围的重要性，并可以帮助指导未来的政策努力。
