Health Insurance–Related Disparities in Colorectal Cancer Screening in Virginia

Bosset, V. De; Atashili, Julius; Miller, William C.; Pignone, Michael

doi:10.1158/1055-9965.epi-07-2760

Cited by 24 publications

(17 citation statements)

References 16 publications

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“…In fact, type of insurance has been shown to impact access to cancer screening, treatment, and outcomes. 27,28 Other social and lifestyle factors, including drug and alcohol abuse, psychiatric illness, obesity, and high-risk behavior, may further contribute to differences in payer group populations. The impact of the economic burden of poverty may also influence patients’ ability to seek medical care and to be discharged from the hospital in a timely manner due to lack of support and resources to be cared for properly at home.…”

Section: Discussionmentioning

confidence: 99%

Primary Payer Status Affects Mortality for Major Surgical Operations

LaPar¹,

Bhamidipati²,

Mery³

et al. 2010

Annals of Surgery

264

188

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Objectives Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following major surgical operations in the United States is dependent on primary payer status. Methods From 2003 to 2007, 893,658 major surgical operations were evaluated using the Nationwide Inpatient Sample (NIS) database: lung resection, esophagectomy, colectomy, pancreatectomy, gastrectomy, abdominal aortic aneurysm repair, hip replacement, and coronary artery bypass. Patients were stratified by primary payer status: Medicare (n = 491,829), Medicaid (n = 40,259), Private Insurance (n = 337,535), and Uninsured (n = 24,035). Multivariate regression models were applied to assess outcomes. Results Unadjusted mortality for Medicare (4.4%; odds ratio [OR], 3.51), Medicaid (3.7%; OR, 2.86), and Uninsured (3.2%; OR, 2.51) patient groups were higher compared to Private Insurance groups (1.3%, P < 0.001). Mortality was lowest for Private Insurance patients independent of operation. After controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions, Medicaid payer status was associated with the longest length of stay and highest total costs (P < 0.001). Medicaid (P < 0.001) and Uninsured (P < 0.001) payer status independently conferred the highest adjusted risks of mortality. Conclusions Medicaid and Uninsured payer status confers increased risk-adjusted mortality. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors or operation. These differences serve as an important proxy for larger socioeconomic and health system-related issues that could be targeted to improve surgical outcomes for US Patients.

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Section: Discussionmentioning

confidence: 99%

Primary Payer Status Affects Mortality for Major Surgical Operations

LaPar¹,

Bhamidipati²,

Mery³

et al. 2010

Annals of Surgery

264

188

View full text Add to dashboard Cite

show abstract

“…Furthermore, Medicaid and Uninsured populations often present with more advanced disease compared to privately insured patients, and patient insurance type has been shown to affect access to cancer screening, treatment, and outcomes. 44, 45 Payer status may also effect hospital discharge processes as discharge from the hospital may be delayed for Medicaid and Uninsured populations due to lack of support and resources to be cared for properly at home. Regarding the Uninsured population.…”

Section: Discussionmentioning

confidence: 99%

Primary Payer Status Is Associated With Mortality and Resource Utilization for Coronary Artery Bypass Grafting

et al. 2012

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Background Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following coronary artery bypass grafting (CABG) in the United States is dependent upon primary payer status. Methods From 2003–2007, 1,250,619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified by primary payer status: Medicare, Medicaid, Uninsured, and Private Insurance. Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes. Results Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%) and Uninsured (1.9%) patients were higher compared to Private Insurance patients (1.1%, p<0.001). Unadjusted length of stay was longest for Medicaid patients (10.9±0.04 days) and shortest for Private Insurance patients (8.0±0.01 days, p<0.001). Medicaid patients accrued the highest unadjusted total costs ($113,380±386, p<0.001). Importantly, after controlling for patient risk factors, income, hospital features, and operative volume, Medicaid (OR=1.82, p<0.001) and Uninsured (OR=1.62, p<0.001) payer status independently conferred the highest adjusted odds of in-hospital mortality. In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (p<0.001). Conclusions Medicaid and Uninsured payer status confers increased risk adjusted in-hospital mortality for patients undergoing coronary artery bypass grafting operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance.

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“…In fact, fewer diagnostic studies during emergency department visits and decreased in-patient hospitalizations following specialty consultations have been documented for these populations compared to private insurance patients 30. Furthermore, Medicaid and Uninsured populations often present with more advanced disease compared to privately insured patients, and patient insurance type has been shown to affect access to cancer screening, treatment, and outcomes 31, 32. Payer status may also effect hospital discharge processes as discharge from the hospital may be delayed for Medicaid and Uninsured populations due to lack of support and resources to be cared for properly at home.…”

Section: Discussionmentioning

confidence: 99%

Primary Payer Status Affects Outcomes for Cardiac Valve Operations

LaPar

Bhamidipati

Walters

et al. 2011

Journal of the American College of Surgeons

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Background Disparities in healthcare have been reported among various patient populations, and the uninsured and Medicaid populations are a significant focus of current healthcare reform. The objective of this study was to examine the influence of primary payer status on outcomes following cardiac valve operations in the United States. Methods From 2003-2007, 477,932 patients undergoing cardiac valve operations were evaluated using discharge data from the Nationwide Inpatient Sample (NIS) database. Records were stratified by primary payer status: Medicare (n=57,249, age=74.0±0.02 yrs), Medicaid (n=5,868, age=41.2±0.13 yrs), Uninsured (n=2,349, age=49.7±0.15 yrs), and Private Insurance (n=31,808, age=53.3±0.04yrs). Multivariate regression models were applied to assess the independent effect of payer status on in-hospital outcomes. Results Preoperative patient risk factors were more common among Medicare and Medicaid populations. Unadjusted mortality and complication rates for Medicare (6.9%, 36.6%), Medicaid (5.7%, 31.4%) and Uninsured (5.2%, 31.4%) patient groups were higher compared to Private Insurance groups (2.9%, 29.9%, p<0.001). Moreover, mortality was lowest for patients with Private Insurance for all types of valve operations. Medicaid patients accrued the longest unadjusted hospital length of stay and highest total hospital costs compared to other payer groups (p<0.001). Importantly, after risk adjustment, Uninsured and Medicaid payer status conferred the highest odds of risk adjusted mortality and morbidity compared to Private Insurance status and were higher than those for Medicare. Conclusions Uninsured and Medicaid payer status is associated with increased risk adjusted in-hospital mortality and morbidity among patients undergoing cardiac valve operations compared to Medicare and Private Insurance. Further, Medicaid patients accrued the longest hospital stays and highest total costs. Primary payer status should be considered as an independent risk factor during preoperative risk stratification and planning.

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Health Insurance–Related Disparities in Colorectal Cancer Screening in Virginia

Cited by 24 publications

References 16 publications

Primary Payer Status Affects Mortality for Major Surgical Operations

Primary Payer Status Affects Mortality for Major Surgical Operations

Primary Payer Status Is Associated With Mortality and Resource Utilization for Coronary Artery Bypass Grafting

Primary Payer Status Affects Outcomes for Cardiac Valve Operations

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