MP6-13 INSURANCE EXPANSION AND THE UTILIZATION OF INPATIENT UROLOGICAL SURGERY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-13 INSURANCE EXPANSION AND THE UTILIZATION OF INPATIENT UROLOGICAL SURGERY Chad Ellimoottil, Sarah Miller, John Wei, and David Miller Chad EllimoottilChad Ellimoottil More articles by this author , Sarah MillerSarah Miller More articles by this author , John WeiJohn Wei More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is anticipated that the Affordable Care Act (ACA) will provide coverage for nearly 25 million previously uninsured individuals in the United States. Because the potential impact of the ACA for urological care delivery remains unknown, we used Massachusetts (MA) healthcare reform as a natural experiment to estimate the impact of insurance expansion on the utilization of inpatient urologic surgeries. METHODS We used discharge data from MA and two control states (New Jersey and New York) to identify nonelderly patients (19-64 years) who underwent inpatient urologic surgery from 2003 through 2010. Using July 2007 as the transition point between pre and post-reform periods, we performed a difference-in-differences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.5 million surgeries performed during the study interval. We observed no increase in the overall rate of inpatient urologic surgery for the entire MA population, but an increase in the rate of inpatient urologic surgery for nonwhite and low income patients (Figure). Our DID analysis confirmed these results (all 2.0%, p=0.431; nonwhites 10.6%, p=0.003; low income 8.1% , p=0.009). At a procedure level, insurance expansion caused increased rates of partial nephrectomy and inpatient BPH procedures, but had no effect on rates of radical prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Although the effect on individual procedures is variable, insurance expansion in Massachusetts increased the overall rate of inpatient urologic surgery for nonwhites and low income patients. These data inform urologists and specialty societies about the potential impact of national insurance expansion for a key aspect of urological care. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e61 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Chad Ellimoottil More articles by this author Sarah Miller More articles by this author John Wei More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...