Impact of the Affordable Care Act on access to accredited facilities for cancer treatment

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-05-02 DOI:10.1111/1475-6773.14315

Lindsay M. Sabik PhD, Youngmin Kwon PhD, Coleman Drake PhD, Jonathan Yabes PhD, Manisha Bhattacharya MD, MBA, Zhaojun Sun PhD, MS, Cathy J. Bradley PhD, Bruce L. Jacobs MD, MPH

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引用次数: 0

Abstract

Objective

To examine differential changes in receipt of surgery at National Cancer Institute (NCI)-designated comprehensive cancer centers (NCI-CCC) and Commission on Cancer (CoC) accredited hospitals for patients with cancer more likely to be newly eligible for coverage under Affordable Care Act (ACA) insurance expansions, relative to those less likely to have been impacted by the ACA.

Data Sources and Study Setting

Pennsylvania Cancer Registry (PCR) for 2010–2019 linked with discharge records from the Pennsylvania Health Care Cost Containment Council (PHC4).

Study Design

Outcomes include whether cancer surgery was performed at an NCI-CCC or a CoC-accredited hospital. We conducted a difference-in-differences analysis, estimating linear probability models for each outcome that control for residence in a county with above median county-level pre-ACA uninsurance and the interaction between county-level baseline uninsurance and cancer treatment post-ACA to capture differential changes in access between those more and less likely to become newly eligible for insurance coverage (based on area-level proxy). All models control for age, sex, race and ethnicity, cancer site and stage, census-tract level urban/rural residence, Area Deprivation Index, and year- and county-fixed effects.

Data Collection/Extraction Methods

We identified adults aged 26–64 in PCR with prostate, lung, or colorectal cancer who received cancer-directed surgery and had a corresponding surgery discharge record in PHC4.

Principal Findings

We observe a differential increase in receiving care at an NCI-CCC of 6.2 percentage points (95% CI: 2.6–9.8; baseline mean = 9.8%) among patients in high baseline uninsurance areas (p = 0.001). Our estimate of the differential change in care at the larger set of CoC hospitals is positive (3.9 percentage points [95% CI: −0.5-8.2; baseline mean = 73.7%]) but not statistically significant (p = 0.079).

Conclusions

Our findings suggest that insurance expansions under the ACA were associated with increased access to NCI-CCCs.

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平价医疗法案》对使用经认证的癌症治疗设施的影响

目的研究在美国国家癌症研究所（NCI）指定的综合癌症中心（NCI-CCC）和癌症委员会（CoC）认可的医院接受手术的癌症患者与那些不太可能受到《可负担医疗法案》（ACA）影响的癌症患者之间的差异变化。数据来源和研究设置2010-2019 年宾夕法尼亚州癌症登记处（PCR）与宾夕法尼亚州医疗成本控制委员会（PHC4）的出院记录相链接。研究设计结果包括癌症手术是否在 NCI-CCC 或 CoC 认证医院进行。我们进行了差异分析，对每项结果的线性概率模型进行了估算，这些模型控制了居住在《美国反垄断法》实施前未参保县级中位数以上的县，以及县级基线未参保与《美国反垄断法》实施后癌症治疗之间的交互作用，以捕捉那些更有可能和更不可能获得新的保险覆盖资格（基于地区级代理）的人在获得保险覆盖方面的不同变化。所有模型都控制了年龄、性别、种族和民族、癌症部位和分期、人口普查区级城市/农村居住地、地区贫困指数以及年份和县固定效应。数据收集/提取方法我们在 PCR 中识别了 26-64 岁患有前列腺癌、肺癌或结直肠癌的成年人，他们接受了癌症导向手术，并且在 PHC4 中有相应的手术出院记录。主要研究结果我们发现，在基线未参保率较高地区的患者中，接受 NCI-CCC 治疗的患者人数增加了 6.2 个百分点（95% CI：2.6-9.8；基线平均值 = 9.8%）（p = 0.001）。我们对较大的 CoC 医院护理差异变化的估计为正值（3.9 个百分点 [95% CI：-0.5-8.2；基线平均值 = 73.7%]），但在统计上并不显著（p = 0.079）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.