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Association of Affordable Care Act-related Medicaid expansion with variation in utilization of surgical services.

Authors
  • McClintock, Tyler R1
  • Gondi, Suhas2
  • Wang, Ye3
  • Friedlander, David F3
  • Cole, Alexander P3
  • Sun, Maxine4
  • Melnitchouk, Nelya5
  • Chang, Steven L3
  • Haider, Adil H5
  • Weissman, Joel S4
  • Trinh, Quoc-Dien6
  • 1 Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA.
  • 2 Harvard Medical School, Boston, MA, USA.
  • 3 Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • 4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • 5 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • 6 Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected]
Type
Published Article
Journal
American journal of surgery
Publication Date
Aug 01, 2020
Volume
220
Issue
2
Pages
441–447
Identifiers
DOI: 10.1016/j.amjsurg.2019.12.017
PMID: 31948702
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We aim to understand how Medicaid expansion under the ACA has affected utilization of surgical services. The State Inpatient Databases were used to compare utilization of a broad array of surgical procedures among nonelderly adults (aged 19-64 years) in a multistate population that experienced ACA-related Medicaid expansion to one that did not. We performed a difference-in-differences (DID) analysis to determine the effect of Medicaid expansion on utilization of surgical services from 2012 to 2014. There were 259,061 cases identified in the Medicaid expansion population and 261,269 in the control population. In the expansion group, there was a smaller decrease in utilization - by a margin of 21.68 cases per 100,000 individuals (p < 0.001). Percent of surgical patients covered by Medicaid increased among the expansion group from 12.00% to 15.48% (DID = 3.93%; p < 0.001). Year one of Medicaid expansion under the ACA was associated with a modest but statistically significant difference in utilization of surgical services as well as an increase in percent of surgery patients covered by Medicaid. Copyright © 2019 Elsevier Inc. All rights reserved.

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