Access to healthcare insurance increases the rates of surgery for diverticulitis

Eguia, Emanuel; Claßen, T; Choudhry, Mashkoor A.; Singer, Marc

doi:10.1080/20479700.2020.1788343

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…[56][57][58] In states that expanded Medicaid coverage, the rate of surgery for diverticular disease increased in Medicaid patients but decreased for those without insurance, indicating that expansion improved access to the surgical management of diverticulitis. 59 Counterfactual models, which estimate the risk of complex presentation if uninsured patients had insurance, predict that the risk of complex presentation would significantly decrease as well. 60 Insurance also impacts postacute follow up care-among patients who underwent surgical intervention with colostomy formation for diverticulitis, patients who were uninsured or had public insurance were less likely to undergo colostomy reversal within 2 years.…”

Section: Diverticulitismentioning

confidence: 99%

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Isenberg,

Harbaugh

2024

Clin Colon Rectal Surg

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Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.

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Section: Diverticulitismentioning

confidence: 99%

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Isenberg,

Harbaugh

2024

Clin Colon Rectal Surg

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Social Determinants of Health in Diverticulitis: A Systematic Review

Ueland,

Vimalathas,

Sweeting

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: There is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed. OBJECTIVE: To assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease. DATA SOURCES: Four electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science. STUDY SELECTION: Included studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded. MAIN OUTCOME MEASURES: Quality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons. RESULTS: Among 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 – 1.29] to 3.83 [3.01 – 4.87]). LIMITATIONS: Retrospective studies, heterogeneity across cohort and variable definitions. CONCLUSIONS: Social determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings. PROSPERO ID: CRD42023422606

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Access to healthcare insurance increases the rates of surgery for diverticulitis

Cited by 2 publications

References 22 publications

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Social Determinants of Health in Diverticulitis: A Systematic Review

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