The Affordable Care Act's Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery

Crocker, Andrew; Zeymo, Alexander; Chan, Kitty S.; Xiao, David; Johnson, Lynt B.; Shara, Nawar; DeLeire, Thomas; Al‐Refaie, Waddah B.

doi:10.1016/j.surg.2018.05.007

Cited by 27 publications

(21 citation statements)

References 18 publications

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“…By reducing rates of uninsurance and increasing rates of Medicaid coverage in expansion states, Medicaid expansion in general led to an increase in the use of both primary care and preventive services (11,12,37), greater access to and use of prescription medications (38,39), and fewer financial barriers to accessing ED and hospital care (18,40). We speculate that this may have led to both earlier presentation to the hospital (18,40,41) and lower rates of severe illness owing to better disease control (42,43).…”

Section: Discussionmentioning

confidence: 99%

Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

Admon¹,

Sjoding²,

Lyon

et al. 2019

Annals ATS

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Rationale: The Affordable Care Act's Medicaid expansion has led to increased access to chronic disease care among newly insured adults. Despite this, its effects on clinical outcomes, particularly for patients with asthma, chronic obstructive pulmonary disease, and heart failure, are uncertain. Objectives: To assess whether Medicaid expansion was associated with changes in mechanical ventilation rates among hospitalized patients with heart failure, asthma, and chronic obstructive pulmonary disease. Methods: Difference-indifferences analysis comparing discharge data from four states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and three comparison states that did not (North Carolina, Nebraska, and Wisconsin) was performed. Models were adjusted for patient and hospital factors. Results: Mechanical ventilation rates at baseline were 7.2% in nonexpansion states and 8.8% in expansion states. Medicaid expansion was associated with a decline in mechanical ventilation rates at 20.2% per quarter (95% confidence interval [CI], 20.3% to 0.0%; P = 0.010). We did not observe a change in the rate of ICU admission (20.4% per quarter; 95% CI, 20.8% to 0.1%; P = 0.10) or in-hospital mortality (0.1% per quarter; 95% CI, 0.0% to 0.1%; P = 0.30). In a negative control among adults aged 65 years or older, changes in mechanical ventilation rates were similar, though the CIs crossed zero (20.1%; 95% CI, 20.2% to 0.0%; P = 0.08). Conclusions: Medicaid expansion may have been associated with a decline in mechanical ventilation rates among uninsured and Medicaid-covered patients admitted with heart failure, chronic obstructive pulmonary disease, and asthma.

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Section: Discussionmentioning

confidence: 99%

Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

Admon¹,

Sjoding²,

Lyon

et al. 2019

Annals ATS

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show abstract

“…Previously conducted ITS analyses focused on the potential role of ACA on utilization of healthcare services have examined specific ACA provisions, including Medicaid expansion [28,29], elimination of cost-sharing expenses for preventive services [17,19], and overall ACA implementation [17,19]. Given the complexity of this issue, few studies specifically focused on cancer diagnosis, prevention and treatment pre-post ACA and these studies yielded inconsistent findings, with evidence for improved healthcare access among underserved populations [17,19] [30].…”

Section: Discussionmentioning

confidence: 99%

Interrupted Time-Series Analysis of Stereotactic Radiosurgery for Brain Metastases Before and After the Affordable Care Act

Beydoun¹,

Huang²,

Beydoun³

et al. 2022

Cureus

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The 2010 Patient Protection and Affordable Care Act was aimed at reducing healthcare costs, improving healthcare quality, and expanding health insurance coverage among uninsured individuals in the United States. We examined trends in the utilization of radiation therapies and stereotactic radiosurgery before and after its implementation among U.S. adults hospitalized with brain metastasis. Interrupted time-series analyses of data on 383,934 Nationwide Inpatient Sample hospitalizations (2005-2010 and 2011-2013) were performed, whereby yearly and quarterly cross-sectional data were evaluated and Affordable Care Act implementation was considered the main exposure variable, stratifying by patient and hospital characteristics. Overall, we observed a declining trend in radiation therapy over time, with an upward shift post-Affordable Care Act. A downward shift in radiation therapy post-Affordable Care Act was observed among Northeastern and rural hospitals, whereas an upward shift was noted among specific patient (females, 18-39 or ≥ 65 years of age, Charlson Comorbidity Index (CCI) ≥10, non-elective admissions, Medicare, self-pay, no pay or other insurance) and hospital (Midwestern, Western, non-teaching urban) subgroups. Stereotactic radiosurgery utilization among recipients of radiation therapy increased over time among Hispanics, elective admissions, and rural hospitals, whereas post-Affordable Care Act was associated with increased stereotactic radiosurgery among African-Americans and non-elective admissions and decreased stereotactic radiosurgery among elective admissions, and rural hospitals. Whereas hospitalized adults in the United States utilized less radiation therapy over the nine-year period, utilization of radiation therapy, in general, and stereotactic radiosurgery, in particular, were not consistent among distinct subgroups defined by patient and hospital characteristics, with some traditionally underserved populations more likely to receive healthcare services post-Affordable Care Act. The Affordable Care Act may be helpful at closing the gap in access to technological advances such as stereotactic radiosurgery for treating brain metastases.

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“…Previously conducted ITS analyses focused on the potential role of ACA on utilization of healthcare services have examined speci c ACA provisions, including Medicaid expansion (9,10,12,13,16,21), elimination of cost-sharing expenses for preventive services (8,17,18,20) and overall ACA implementation (8,11,15,17,19,20). Given the complexity of this issue, few studies speci cally focused on cancer diagnosis, prevention and treatment prepost ACA and these studies yielded inconsistent ndings, with evidence for improved healthcare access among underserved populations (8,10,11,14,15,(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Interrupted Time-Series for the Evaluation of Affordable Care Act Impact on Stereotactic Radiosurgery for the Treatment of Brain Metastases

Beydoun¹,

Huang²,

Beydoun³

et al. 2021

Preprint

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Background: The 2010 Affordable Care Act aimed at reducing healthcare costs, improving healthcare quality and expanding health insurance coverage among uninsured individuals in the United States. We examined trends in utilization of radiation therapies and stereotactic radiosurgery before and after its implementation among U.S. adults hospitalized with brain metastasis.Methods: Interrupted time-series analyses of data on 383934 2005-2014 Nationwide Inpatient Sample hospitalizations were performed, whereby yearly and quarterly cross-sectional data were evaluated and Affordable Care Act implementation was considered the main exposure variable, stratifying by patient and hospital characteristics. Results: We observed consistently declining trends in radiation therapy over time and post-Affordable Care Act status with variability in level of utilization among specific sub-groups. Stereotactic radiosurgery prevalence increased over time among Hispanics, elective admissions, Midwestern hospitals, non-teaching hospitals and hospitals with medium bed size. Post-Affordable Care Act was associated with increased stereotactic radiosurgery prevalence among African-Americans, non-elective and weekend admissions, with changes in slope in the context of weekend admissions and hospitals with large bed size. Conclusions: Whereas hospitalized adults in the United States utilized less radiation therapy and slightly more stereotactic radiosurgery over the ten-year period, utilization levels and trends were not consistent among distinct sub-groups defined by patient and hospital characteristics, with some traditionally underserved populations more likely to receive healthcare services post-Affordable Care Act implementation. The Affordable Care Act may be helpful at reducing the need for radiation therapy and closing the gap in access to technological advances such as stereotactic radiosurgery for treating brain metastases.

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The Affordable Care Act's Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery

Cited by 27 publications

References 18 publications

Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

Interrupted Time-Series Analysis of Stereotactic Radiosurgery for Brain Metastases Before and After the Affordable Care Act

Interrupted Time-Series for the Evaluation of Affordable Care Act Impact on Stereotactic Radiosurgery for the Treatment of Brain Metastases

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