Massachusetts health reform and disparities in joint replacement use: difference in differences study

Hanchate, Amresh; Kapoor, Alok; Katz, Jeffrey N.; McCormick, Danny; Lasser, Karen E.; Feng, Chen; Manze, Meredith; Kressin, Nancy R.

doi:10.1136/bmj.h440

Cited by 38 publications

(30 citation statements)

References 47 publications

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“…39 Multiple studies have suggested increased surgical referrals and decreased disparities in the receipt of certain procedures after expanded insurance coverage. [40][41][42][43][44][45] However, our data do contrast another recent study that found no change in disparities of coronary revascularization procedures after Massachusetts health care reform, although their analysis was limited by short follow-up data ending in September of 2008, only nine months after implementation of mandate requiring insurance coverage. 46 The HCUP-SID capture nearly 100% of all inpatient admissions across states but are bound by the limitations of administrative data, including the possibility of coding discrepancies and limited clinical granularity better captured in clinical datasets.…”

Section: Discussioncontrasting

confidence: 55%

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Loehrer¹,

Hawkins²,

Auchincloss³

2016

Journal of Vascular Surgery

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STRUCTURED ABSTRACTObjective-To evaluate the impact of health insurance expansion on racial disparities in severity of peripheral arterial disease.Summary Background Data-Lack of insurance and non-white race are associated with increased severity, increased amputation rates, and decreased revascularization rates in patients with peripheral artery disease (PAD). Little is known about how expanded insurance coverage affects disparities in presentation with and management of PAD. The 2006 Massachusetts health reform expanded coverage to 98% of residents and provided the framework for the Affordable Care Act.Methods-We performed a retrospective cohort study of non-elderly, white and non-white patients admitted with PAD in Massachusetts (MA) and four control states. Risk-adjusted difference-in-difference models were used to evaluate changes in probability of presenting with severe disease. Multivariable linear regression models evaluated disparities in disease severity before and after the 2006 health insurance expansion.Results-Prior to the 2006 MA insurance expansion, non-white patients in both MA and control states had a 12-13 percentage-point higher probability of presenting with severe disease (P<0.001) than white patients. After the expansion, measured disparities in disease severity by patient race were no longer statistically significant in Massachusetts (+3.0 percentage-point difference, P=0.385) while disparities persisted in control states (+10.0 percentage-point difference, P<0.001). Overall, non-white patients in MA had an 11.2 percentage-point decreased probability of severe PAD (P=0.042) relative to concurrent trends in control states. Conclusions-The 2006Massachusetts insurance expansion was associated with a decreased probability of patients presenting with severe PAD and resolution of measured racial disparities in severe PAD in MA.

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Section: Discussioncontrasting

confidence: 55%

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Loehrer¹,

Hawkins²,

Auchincloss³

2016

Journal of Vascular Surgery

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“…9 Similar trends were also observed after the Massachusetts state expansion. 16 Second, the increase in Medicaid-paid cases was not enough to compensate for the decrease in private insurance cases. The decrease in the inflation-adjusted reimbursement rate for elective surgery from New York Medicaid program, during most of our study period, did not appear to have motivated providers to replace all of their private insurance cases with Medicaid cases.…”

Section: Discussionmentioning

confidence: 99%

Did Pre-Affordable Care Act Medicaid Expansion Increase Access to Surgical Cancer Care?

Al‐Refaie

Zheng

Jindal³

et al. 2017

Journal of the American College of Surgeons

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BACKGROUND Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York’s 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities. STUDY DESIGN From the New York State Inpatient Database (1997 to 2006), we identified 67,685 nonelderly adults (18 to 64 years of age) who underwent cancer surgery. Estimated effects of 2001 Medicaid expansion on access were measured on payer mix, overall use of surgical cancer care, and percent use by racial/ethnic minorities. Measures were calculated quarterly, adjusted for covariates when appropriate, and then analyzed using interrupted time series. RESULTS The proportion of cancer operations paid by Medicaid increased from 8.9% to 15.1% in the 5 years after the expansion. The percentage of uninsured patients dropped by 21.3% immediately after the expansion (p = 0.01). Although the expansion was associated with a 24-case/year increase in the net Medicaid case volume (p < 0.0001), the overall all-payer net case volume remained unchanged. In addition, the adjusted percentage of ethnic minorities among Medicaid recipients of cancer surgery was unaffected by the expansion. CONCLUSIONS Pre-ACA Medicaid expansion did not increase the overall use or change the racial composition of beneficiaries of surgical cancer care. However, it successfully shifted the financial burden away from patient/hospital to Medicaid. These results might suggest similar effects in the post-ACA Medicaid expansion.

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“…Median life expectancy grew from 60 to 70 years worldwide from 1990 to 2012 and will increase in the future 13 . As healthy life expectancy continues to increase, more elderly people are likely to undergo operation, although there are some ethnic and geographic differences 14,15 .…”

Section: Future Trendsmentioning

confidence: 99%

“…Interestingly, the economic downturn in the USA did not influence utilization rates for knee and hip athroplasty 2 . The expansion of universal health insurance can help to reduce disparities in access to elective surgery according to race/ ethnicity but not according to income 15 . As meta analyses show, a weight loss of only 5% reduces disability significantly and a weight reduction of 10% improves function by 28%, which could contribute to a reduced need for knee arthroplasty 17,18 .…”

Section: Future Trendsmentioning

confidence: 99%

Utilization rates of knee-arthroplasty in OECD countries

Pabinger

Lothaller

Geißler

2015

Osteoarthritis and Cartilage

176

138

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We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030.

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Massachusetts health reform and disparities in joint replacement use: difference in differences study

Abstract: Objective To estimate the impact of the insurance expansion in 2006 on use of knee and hip replacement procedures by race/ethnicity, area income, and the use of hospitals that predominantly serve poor people ("safety net hospitals").

Cited by 38 publications

References 47 publications

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Did Pre-Affordable Care Act Medicaid Expansion Increase Access to Surgical Cancer Care?

Utilization rates of knee-arthroplasty in OECD countries

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