Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

Sommers, Benjamin D.; Blendon, Robert J.; Orav, E. John; Epstein, Arnold M.

doi:10.1001/jamainternmed.2016.4419

Cited by 433 publications

(420 citation statements)

References 32 publications

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“…Especially in light of the ongoing discussion around the fate of Medicaid expansion, this study importantly demonstrates that limited care management resources can be directed at those most likely to benefit [12]. It supports the assumption that certain barriers to compliance with treatment plans are important determinants of future total cost of care and can be addressed at the individual patient level by the care manager either directly or by referral to social service agencies.…”

Section: Resultssupporting

confidence: 68%

Predictive Value of Screening for Addressable Social Risk Factors

Lemak¹

2017

CMPH

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ResultsAlthough many managed care networks do not systematically collect social and behavioral risk factors in a medical setting, social risk factors are associated with an increase in healthcare costs. Healthcare costs were $65 Per Member Per Month higher for beneficiaries who had trouble securing food, clothing, or housing (95% Confidence Interval [CI], $10 to $119; P=0.02). The presence of 1-3 addressable risk factors is associated with $132 higher Per Member Per Month spending, even when both groups reported infrequent hospitalizations (95% Confidence Interval [CI], $77 to $188; P<0.001). ConclusionSocial risk factors lead to an increase in healthcare cost and utilization even after controlling for past hospital utilization, chronic conditions, age, and gender. Managed care networks should routinely screen for social factors to target at-risk patients to better manage long-term healthcare costs.

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Section: Resultssupporting

confidence: 68%

Predictive Value of Screening for Addressable Social Risk Factors

Lemak¹

2017

CMPH

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“…Indeed, a delay in diagnosis substantially increases the risk of an advanced stage of disease at presentation, which is significantly associated with decreased survival 29, 30, 31, 32. However, with the increasing improvement of health care policies and medical insurance, the patients with low income could also have access to medical consultation and better treatment resources, thereby they could have a progress survival over time 33, 34…”

Section: Discussionmentioning

confidence: 99%

Increased survival of patients aged 0‐29 years with osteosarcoma: A period analysis, 1984‐2013

Sun

et al. 2018

Cancer Medicine

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PurposeOsteosarcoma is the most common primary malignancy of bone, and typically occurs among children and adolescence. This study aims to evaluate treatment outcomes among children, adolescents and young adults with osteosarcoma over the three decades by the changes in the long‐term relative survival.MethodsOsteosarcoma incidence and relative survival data from Surveillance, Epidemiology, and End Results (SEER) registries during 1984‐2013 were analyzed. The survival differences over three decades, age, sex, race, and socioeconomic status (SES) were assessed by comparing Kaplan‐Meier curves.ResultsThe overall incidence of osteosarcoma kept relatively stable with 0.4 per 100 000 in the three decades with the peak incidence occurring in the aged 10‐19 group. The 10‐year relative survival rate (RSR) increased from 57.7% to 61.0% in the three decades, with the greatest increase in the aged 0‐9 group from 48.2% to 65.7%. The 10‐year RSR improved from 54.1% to 61.5% in males, and from 62.4% to 63.0% in females, respectively, in the three decades. Furthermore, survival dramatically improved from 30% to 60% in the high‐poverty group over the three decades.ConclusionThis study demonstrated that the overall incidence of osteosarcoma remained stable, with an improvement in survival in the three decades. The improved survival was greater in males than in females in the three decades. Furthermore, the survival significantly increased in high‐poverty group, which was attributed to increasing improved health care system and patients with low finance can also have access to receiving effective and consistent treatment without distinction.

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“…Such behavior is consistent with the Oregon health insurance experiment and numerous ACA-related studies that show Medicaid coverage to be associated with decreased delays in seeking care and increased use of emergency room, primary care, and outpatient clinics. 4,5,37 Having presented earlier in the clinical progression or deterioration of their conditions, patients may be more likely to receive optimal management with decreased morbidity and improved outcomes. Additionally, hospitals may be more willing to provide care for newly-insured individuals who previously lacked coverage.…”

Section: 43233mentioning

confidence: 99%

“…[3][4][5] However, the clinical impact of coverage expansion on patients with common and serious surgical conditions remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

et al. 2018

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IMPORTANCE Lack of insurance coverage has been associated with delays in seeking care, more complicated diseases at the time of diagnosis, and decreased likelihood of receiving optimal surgical care. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansion has increased coverage among millions of low-income Americans, but its effect on care for common surgical conditions remains unknown. OBJECTIVE To evaluate the association of the ACA's Medicaid expansion with access to timely and recommended care for common and serious surgical conditions. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, difference-in-differences study used hospital administrative data to compare patient-level outcomes in expansion vs nonexpansion states before (2010-2013) vs after (2014-2015) expansion. A total of 293 529 patients aged 18 to 64 years with appendicitis, cholecystitis, diverticulitis, peripheral artery disease (PAD), or aortic aneurysm admitted to an academic medical center or affiliated hospital in 27 Medicaid expansion states and 15 nonexpansion states from January 1, 2010, through September 31, 2015, were included in the study. Data analysis was performed from November 1, 2016, to March 3, 2017. EXPOSURES State adoption of Medicaid expansion.MAIN OUTCOMES AND MEASURES Presentation with early uncomplicated disease (diverticulitis without abscess, fistula, or sepsis; nonruptured aortic aneurysm at time of repair; and PAD without ulcerations or gangrene) and receipt of optimal management (cholecystectomy for acute cholecystitis, laparoscopic approach for cholecystectomy or appendectomy, and limb salvage for PAD). RESULTSOf the 293 529 study patients (128 392 [43.7%] female and 165 137 [56.3%] male), 225 572 had admissions in Medicaid expansion states and 67 957 had admissions in nonexpansion states. Medicaid expansion was associated with a 7.5-percentage point decreased probability of patients being uninsured (95% CI, −12.2 to −2.9; P = .002) and an 8.6-percentage point increased probability of having Medicaid (95% CI, 6.1-11.1; P < .001). Medicaid expansion was associated with a 1.8-percentage point increase in the probability of early uncomplicated presentation (95% CI, 0.7-2.9; P = .001) and a 2.6-percentage point increase in the probability of receiving optimal management (95% CI, 0.8-4.4; P = .006). CONCLUSIONS AND RELEVANCEThe ACA's Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions. Health care systems and policymakers should be aware of the influence of insurance coverage expansion (or its repeal) on presentation with and management of surgical disease.

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Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

Cited by 433 publications

References 32 publications

Predictive Value of Screening for Addressable Social Risk Factors

Predictive Value of Screening for Addressable Social Risk Factors

Increased survival of patients aged 0‐29 years with osteosarcoma: A period analysis, 1984‐2013

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

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