Department of Surgery, City of Hope National Medical Center, Duarte, CA.
The Commonwealth Fund, New York, NY.
Ann Surg. 2021 Oct 1;274(4):e315-e319. doi: 10.1097/SLA.0000000000005098.
To determine how Medicare Advantage (MA) health plan networks impact access to high-volume hospitals for cancer surgery.
Cancer surgery at high-volume hospitals is associated with better short- and long-term outcomes. In the United States, health insurance is a major detriment to seeking care at high-volume hospitals. A third of older (>65 years) Americans are enrolled in privatized MA health plans. The impact of MA plan networks on access to high-volume surgery hospitals is unknown.
We analyzed in-network hospitals for MA plans offered in Los Angeles county during open enrollment of 2015. For the purposes of this analysis, MA network data from provider directories were linked to hospital volume data from California Office of Statewide Health Planning and Development. Volume thresholds were based on published literature.
A total of 34 MA plans enrolled 554,754 beneficiaries in Los Angeles county during 2014 open enrollment for coverage starting in 2015 (MA penetration ∼43%). The proportion of MA plans that included high-volume cancer surgery hospital varied by the type of cancer surgery. While most plans (>71%) included at least one high-volume hospital for colon, rectum, lung, and stomach; 59% to 82% of MA plans did not include any high-volume hospitals for liver, esophagus, or pancreatic surgery. A significant proportion of beneficiaries in MA plans did not have access to high-volume hospitals for esophagus (93%), stomach (44%), liver (39%), or pancreas (70%) surgery. In contrast, nearly all MA beneficiaries had access to at least one high-volume hospital for lung (93%), colon (100%), or rectal (100%) surgery. Overall, Centers for Medicare & Medicaid Services plan rating or plan popularity were not correlated with access to high-volume hospital (P > 0.05).
The study identifies lack of high-volume hospital coverage in MA health plans as a major detriment in regionalization of cancer surgery impacting at least a third of older Americans.
确定医疗保险优势（MA）健康计划网络如何影响癌症手术的高容量医院的获得。
在大容量医院进行癌症手术与更好的短期和长期结果相关。在美国，医疗保险是在大容量医院寻求治疗的主要障碍。超过三分之一的（>65 岁）美国老年人参加了私有化的 MA 健康计划。MA 计划网络对获得大容量手术医院的影响尚不清楚。
我们分析了 2015 年开放注册期间洛杉矶县 MA 计划的联网医院。在这项分析中，MA 网络数据来自提供者目录，并与加利福尼亚州全州卫生规划和发展办公室的医院容量数据相链接。容量阈值基于已发表的文献。
在 2014 年开放注册期间，共有 34 个 MA 计划在洛杉矶县招募了 554754 名受益人为 2015 年开始的保险（MA 渗透率约为 43%）。包含高容量癌症手术医院的 MA 计划比例因癌症手术类型而异。虽然大多数计划（>71%）至少包括一家用于结肠、直肠、肺和胃的高容量医院；但 59%至 82%的 MA 计划没有包括任何用于肝、食管或胰腺手术的高容量医院。相当一部分 MA 计划的受益患者无法获得高容量的食管（93%）、胃（44%）、肝（39%）或胰腺（70%）手术医院。相比之下，几乎所有 MA 受益患者都可以至少获得一家用于肺（93%）、结肠（100%）或直肠（100%）手术的高容量医院。总体而言，医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的计划评级或计划受欢迎程度与获得高容量医院之间没有相关性（P>0.05）。
该研究确定 MA 健康计划中缺乏高容量医院覆盖是癌症手术区域化的一个主要障碍，至少影响三分之一的美国老年人。
