Department of Surgery, City of Hope National Medical Center, Duarte, CA.
Department of Economics, University of California Irvine, Irvine, CA.
J Clin Oncol. 2023 Feb 20;41(6):1239-1249. doi: 10.1200/JCO.21.01359. Epub 2022 Nov 10.
Nearly half of all Medicare beneficiaries are enrolled in privatized Medicare insurance plans (Medicare Advantage [MA]). Little comparative information is available about access, outcomes, and cost of inpatient cancer surgery between MA and Traditional Medicare (TM) beneficiaries. We set out to assess and compare access, postoperative outcomes, and estimated cost of inpatient cancer surgery among MA and TM beneficiaries.
Retrospective cohort analysis of MA or TM beneficiaries undergoing elective inpatient cancer surgery (for cancers located in lung, esophagus, stomach, pancreas, liver, colon, or rectum) was performed using the Office of Statewide Health Planning Inpatient Database linked to California Cancer Registry from 2000 to 2020. For each cancer site, risk-standardized access to high-volume hospitals, postoperative 30-day mortality, complications, failure to rescue, and surgery-specific estimated costs were compared between MA and TM beneficiaries.
This analysis of 76,655 Medicare beneficiaries (median age 74 years, 51% female, 39% MA) included 31,913 colectomies, 10,358 proctectomies, 4,604 hepatectomies, 2,895 pancreatectomies, 3,639 gastrectomies, 1,555 esophagectomies, and 21,691 lung resections. Except for colon surgery, MA beneficiaries were less likely to receive care at a high-volume hospital. Mortality was significantly higher among MA beneficiaries ( TM) for gastrectomy (adjusted risk difference [ARD], 1.5%; 95% CI, 0.01 to 2.9; = .036), pancreatectomy (ARD, 2.0%; CI, 0.80 to 3.3; = .002), and hepatectomy (ARD, 1.4%; 95% CI, 0.1 to 2.9; = .04). By contrast, compared with TM, MA beneficiaries incurred lower estimated hospital costs.
Enrollment in MA plan is associated with lower estimated hospital costs. However, compared with TM, MA beneficiaries had lower access to high-volume hospitals and increased 30-day mortality for stomach, pancreas, or liver surgery.
近一半的医疗保险受益人参加了私有化医疗保险计划（医疗保险优势计划[MA]）。关于 MA 和传统医疗保险（TM）受益人的住院癌症手术的可及性、结果和成本，几乎没有比较信息。我们旨在评估和比较 MA 和 TM 受益人的可及性、术后结果以及住院癌症手术的估计成本。
使用 Office of Statewide Health Planning Inpatient Database 对 2000 年至 2020 年期间接受择期住院癌症手术（位于肺、食管、胃、胰腺、肝、结肠或直肠的癌症）的 MA 或 TM 受益人进行回顾性队列分析，并与加利福尼亚癌症登记处进行链接。对于每个癌症部位，比较 MA 和 TM 受益人在高容量医院的风险标准化可及性、术后 30 天死亡率、并发症、救援失败和手术特定估计成本。
这项对 76655 名医疗保险受益人的分析（中位年龄 74 岁，女性占 51%，MA 占 39%）包括 31913 例结肠切除术、10358 例直肠切除术、4604 例肝切除术、2895 例胰腺切除术、3639 例胃切除术、1555 例食管切除术和 21691 例肺切除术。除结肠手术外，MA 受益人在高容量医院接受治疗的可能性较小。MA 受益人的死亡率明显更高（TM）胃切除术（调整风险差异[ARD]，1.5%；95%CI，0.01 至 2.9； =.036）、胰腺切除术（ARD，2.0%；CI，0.80 至 3.3； =.002）和肝切除术（ARD，1.4%；95%CI，0.1 至 2.9； =.04）。相比之下，与 TM 相比，MA 受益人的估计住院费用较低。
参加 MA 计划与较低的估计住院费用相关。然而，与 TM 相比，MA 受益人接受高容量医院治疗的机会较低，并且胃、胰腺或肝脏手术的 30 天死亡率增加。
