The effects of the Affordable Care Act on access and outcomes of colon surgery

被引:4
|
作者
Brooks, Ezra S. [1 ]
Tong, Jason [2 ]
Mavroudis, Catherine W. [2 ]
Wirtalla, Christopher [2 ]
Karakousis, Giorgos C. [2 ]
Saur, Nicole M. [3 ]
Aarons, Cary B. [3 ]
Mahmoud, Najjia N. [2 ]
Kelz, Rachel R. [2 ]
机构
[1] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
[2] Univ Penn, Ctr Surg & Hlth Econ, Dept Surg, Philadelphia, PA 19104 USA
[3] Univ Penn, Dept Surg, Philadelphia, PA 19104 USA
来源
AMERICAN JOURNAL OF SURGERY | 2021年 / 222卷 / 03期
关键词
Affordable care act; Colon resection; Emergent presentation; Mortality; RACIAL DISPARITIES; MEDICAID EXPANSION; ETHNIC DISPARITIES; EMERGENCY-SURGERY; CANCER; IMPACT; PREDICTORS; COVERAGE; QUALITY; PATIENT;
D O I
10.1016/j.amjsurg.2021.01.019
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Insurance status has been strongly associated with both access to and outcomes of colon resection (CRS). Under the Affordable Care Act (ACA), individual states opted to participate in Medicaid expansion (ME) and adopt essential health benefits (EHB). Methods: We performed a quasi-experimental difference-in-differences (DID) analysis of 2012-2017 state-level inpatient claims with risk adjustment. We examined frequency of emergent presentation and in-hospital death. Subset analyses were performed by insurance type. Results: Among the 73,961 CRS patients, 49.6% were in a state with both ME and EHB, 34.7% presented emergently, and 2.0% died. Adoption of ME and EHB was associated with a significant, 24%, reduction in the likelihood of in-hospital mortality, and no significant change in emergent presentation for CRS. Conclusions: The ACA's ME was strongly associated with a decrease in mortality following colon resection among Medicaid beneficiaries. These findings support the adoption of healthcare policies that improve access to insurance. (C) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:613 / 618
页数:6
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