Effect of insurance expansion on utilization of inpatient surgery.

ABSTRACT: IMPORTANCE:Enhanced access to preventive and primary care services is a primary focus of the Affordable Care Act, but the potential effect of this law on surgical care is not well defined. OBJECTIVE:To estimate the differential effect of insurance expansion on utilization of discretionary vs nondiscretionary inpatient surgery with Massachusetts health care reform as a natural experimental condition. DESIGN, SETTING, AND PARTICIPANTS:We used the state inpatient databases from Massachusetts and 2 control states (New Jersey and New York) to identify nonelderly adult patients (aged 19-64 years) who underwent discretionary vs nondiscretionary surgical procedures from January 1, 2003, through December 31, 2010. We defined discretionary surgery as elective, preference-sensitive procedures (eg, joint replacement and back surgery) and nondiscretionary surgery as imperative and potentially life-saving procedures (eg, cancer surgery and hip fracture repair). EXPOSURE:All surgical procedures in the study and control populations. MAIN OUTCOMES AND MEASURES:Using July 1, 2007, as the transition point between the prereform and postreform periods, we performed a difference-in-differences analysis to estimate the effect of insurance expansion on rates of discretionary and nondiscretionary surgical procedures in the entire study population and for subgroups defined by race, income, and insurance status. We then extrapolated our results from Massachusetts to the entire US population. RESULTS:We identified a total of 836?311 surgical procedures during the study period. Insurance expansion was associated with a 9.3% increase in the use of discretionary surgery in Massachusetts (P?=?.02). Conversely, the rate of nondiscretionary surgery decreased by 4.5% (P?=?.009). We found similar effects for discretionary surgery in all subgroups, with the greatest increase observed for nonwhite participants (19.9% [P?

SUBMITTER: Ellimoottil C 

PROVIDER: S-EPMC4209916 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature