Medicaid expansion and surgery for HPB/GI cancers: NCDB difference-in-difference analysis

It is unclear if Medicaid expansion improved access to surgical resection for hepatopancreatobiliary (HPB) and gastrointestinal (GI) cancers. This was a quasi-experimental, cohort study using difference-in-difference analysis to evaluate differences in surgical resection for HPB/GI cancers in the po...

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Bibliographic Details
Published in:The American journal of surgery 2023-02, Vol.225 (2), p.328-334
Main Authors: Kaelberer, Zoey, Ruan, Mengyuan, Lam, Miranda B., Brindle, Mary, Molina, George
Format: Article
Language:English
Subjects:
Adult
Affordable care act
Cohort Studies
Gastric cancer
Gastrointestinal Neoplasms
Government programs
Health insurance
Humans
Insurance Coverage
Liver
Liver cancer
Liver Neoplasms
Medicaid
Metastases
Middle Aged
Pancreatic cancer
Pancreatic Neoplasms
Patient Protection and Affordable Care Act
Surgeons
United States
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Summary:It is unclear if Medicaid expansion improved access to surgical resection for hepatopancreatobiliary (HPB) and gastrointestinal (GI) cancers. This was a quasi-experimental, cohort study using difference-in-difference analysis to evaluate differences in surgical resection for HPB/GI cancers in the post-Medicaid expansion era compared to the pre-Medicaid expansion era among patients residing in states that had Medicaid expansion versus not. During the pre- (2011–2013) and post-Medicaid expansion (2015–2017) eras, there were 49,954 patients between the ages of 40–64 who had liver cancer (n = 19,384; 38.8%), pancreatic cancer (n = 14,351; 28.7%), colorectal liver metastasis (n = 7566; 15.1%), or gastric cancer (n = 8653; 17.3%). 43.2% resided in expansion states (n = 21,577). There were no significant differences in the overall rates of surgical resection between expansion and non-expansion states before and after Medicaid expansion. Medicaid expansion did not impact surgical resection for HPB/GI cancers. •Medicaid expansion was not associated with patients undergoing surgical resection for HPB/GI cancers.•These findings persisted among a cohort of patients that only included Medicaid insurance or who were insured.•Patients in Medicaid expansion states were more likely to visit academic/research facilities after Medicaid expansion.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2022.09.004