Dataset Information

Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.

ABSTRACT:

Background

Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear.

Aims

To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation.

Methods

We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival.

Results

Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure.

Conclusion

Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.

SUBMITTER: Akateh C

PROVIDER: S-EPMC6425937 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Publications

Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.

Akateh Clifford C Tumin Dmitry D Beal Eliza W EW Mumtaz Khalid K Tobias Joseph D JD Hayes Don D Black Sylvester M SM

Digestive diseases and sciences 20180324 6

<h4>Background</h4>Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear.<h4>Aims</h4>To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation.<h4>Methods</h4>We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categor ...[more]

PMID: 29574563

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Project description:The Affordable Care Act has provided health insurance to a large portion of the uninsured in the United States. However, different types of health insurance provide varying amounts of reimbursements to providers, which may lead to different types of treatment, potentially worsening health outcomes in patients covered by low-reimbursement insurance plans, such as Medicaid. The objective was to determine differences in access, treatment, and health outcomes by insurance type, using hospital fixed effects. We conducted a multivariate regression analysis using patient-level data for nonelderly adult patients with acute myocardial infarction in California from January 1, 2001, to December 31, 2014, as well as hospital-level information to control for differences between hospitals. The probability of Medicaid-insured and uninsured patients having access to catheterization laboratory was higher by 4.50 and 3.75 percentage points, respectively, relative to privately insured patients. When controlling for access to percutaneous coronary intervention facilities, however, Medicaid-insured and uninsured patients had a 4.24- and 0.85-percentage point lower probability, respectively, in receiving percutaneous coronary intervention treatment compared with privately insured patients. They also had higher mortality and readmission rates relative to privately insured patients. Although Medicaid-insured and uninsured patients with acute myocardial infarction had better access to catheterization laboratories, they had significantly lower probabilities of receiving percutaneous coronary intervention treatment and a higher likelihood of death and readmission compared with privately insured patients. This provides empirical evidence that treatment received and health outcomes strongly vary between Medicaid-insured, uninsured, and privately insured patients, with Medicaid-insured patients most disproportionately affected, despite having better access to cardiac technology.

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Dataset Information

Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.

Background

Aims

Methods

Results

Conclusion

Publications

Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.

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