Effects of health insurance and race on colorectal cancer treatments and outcomes

Roetzheim, Richard G.; Pal, Naazneen; Gonzalez, Eduardo; Ferrante, Joan M.; Durme, Daniel J. Van; Krischer, Jeffrey P.

doi:10.2105/ajph.90.11.1746

Cited by 214 publications

(49 citation statements)

References 62 publications

(59 reference statements)

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“…U.S. Census data published in 2012 showed that 15.4%, or 48 million Americans, went uncovered by health insurance, and Medicaid covered 16.4%, or 51 million Americans (DeNavas-Walt, US census bureau, 2013). Lack of insurance coverage has been associated with worse survival and postoperative complications in critical illness (21), trauma (22), breast cancer (23), uterine cancer (24), colorectal cancer (25, 26), prostate cancer (27), diffuse large cell lymphoma (28), head and neck cancer (29), and lung cancer (30). Attributable causes for worse clinical outcomes in uninsured Americans include more advanced disease at time of diagnosis, fewer diagnostic tests performed, and decreased healthcare literacy (31, 32).…”

Section: Discussionmentioning

confidence: 99%

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Melvan

Sancheti

Gillespie

et al. 2015

Journal of the American College of Surgeons

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Background Clinical variables associated with 30-day mortality after lung cancer surgery are well known. However, the effects of non-clinical factors, including insurance coverage, household income, education, type of treatment center, and area of residence, on short term survival are less appreciated. We studied the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify disparities in 30-day mortality after lung cancer resection based on these non-clinical factors. Study Design We performed a retrospective cohort analysis of patients undergoing lung cancer resection from 2003-2011, using the NCDB. Data were analyzed using a multivariable logistic regression model to identify risk factors for 30-day mortality. Results 215,645 patients underwent lung cancer resection during our study period. We found that clinical variables such as age, gender, comorbidity, cancer stage, preoperative radiation, extent of resection, positive surgical margins, and tumor size were associated with 30-day mortality after resection. Non-clinical factors including living in lower income neighborhoods with a lesser proportion of high school graduates, and receiving cancer care at a non-academic medical center were also independently associated with increased 30-day postoperative mortality. Conclusions This study represents the largest analysis of 30-day mortality for lung cancer resection to date from a generalizable national cohort. Our results demonstrate that, in addition to known clinical risk factors, several non-clinical factors are associated with increased 30-day mortality after lung cancer resection. These disparities require further investigation to improve lung cancer patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Melvan

Sancheti

Gillespie

et al. 2015

Journal of the American College of Surgeons

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“…14–17 The findings are also important, considering that the uninsured are often reluctant to seek care due to concerns about cost and, as a result, often have worse health outcomes. 6,14,15,29–31 With the increase in Medicaid coverage, perhaps more patients in New York were willing to seek out and receive specialty care. Similar results were reported by Hanchate and colleagues, who reported that use of inpatient surgical procedures increased after institution of universal coverage in Massachusetts.…”

Section: Discussionmentioning

confidence: 99%

“…This issue is of particular interest because Medicaid beneficiaries already encounter substantial difficulties in accessing specialty services. 6,14–18 We used the largest natural experiment of Medicaid-only expansion, in New York State in 2001, 19,20 to evaluate the effects of this policy change on use of inpatient plastic and reconstructive surgery procedures by Medicaid beneficiaries. We also assessed use by patients without health insurance coverage (ie, uninsured) to understand if expanding Medicaid resulted in reduced access to previously available care for those who remained uninsured.…”

mentioning

confidence: 99%

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

Giladi

Aliu

Chung

2014

Journal of the American College of Surgeons

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BACKGROUND Understanding the benefits of Medicaid is crucial as states decide whether to expand Medicaid under the Patient Protection and Affordable Care Act. We used the 2001 Medicaid expansion in New York to evaluate changes in use by Medicaid beneficiaries and the uninsured of breast cancer reconstruction, panniculectomy, and lower-extremity trauma management. METHODS Data for all patients 19 to 64 years old having undergone the selected procedures between 1998 and 2006 were obtained from the State Inpatient Database. We used an interrupted time series using variance weighted least squares regression to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients received the procedures. We also determined the predicted use had there been no expansion. New York Census data were used for population-adjusted case-volume calculations. RESULTS Likelihood of Medicaid as the primary payer increased significantly after expansion, 0.34% per quarter (95% CI, 0.28–0.40), without a decrease in uninsured patients receiving these procedures. This resulted in a 7.2% increase in the proportion of Medicaid beneficiaries receiving these procedures, an additional 1.9 Medicaid cases per quarter per 100,000 New York residents. In subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction (0.28% per quarter; 95% CI, 0.21–0.35) and panniculectomy (0.19% per quarter; 95% CI, 0.1–0.28) without a decrease for the uninsured. Lower-extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight increase for Medicaid beneficiaries (not significant). CONCLUSIONS Subspecialty surgeons responded to expansion by increasing volume of procedures for Medicaid beneficiaries. This occurred without decline in care for the uninsured, suggesting that Medicaid expansion resulted in increased access for underserved patients. Although more patients received needed care once they had coverage, subgroup analysis identified persistence of additional barriers to use of certain surgical services.

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“…Whether suffering acute coronary syndrome or breast or colorectal cancers, uninsured patients have been found to present at later more severe stages of illness and disease often necessitating more resource-intensive care and suffering worse outcomes (47-50). Review of hospital and ICU service utilization in Massachusetts following a decrease in the uninsured population rate from 9.3% to 5.1% found no significant change in ICU admission rates or mortality (51).…”

Section: Discussionmentioning

confidence: 99%

Critical Care Implications of the Affordable Care Act

Dogra

Dorman

2016

Critical Care Medicine

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Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era.

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Effects of health insurance and race on colorectal cancer treatments and outcomes

Cited by 214 publications

References 62 publications

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

Critical Care Implications of the Affordable Care Act

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