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Massachusetts Health Insurance Expansion Associated With Increased Resection and Reduced Emergent Resection for Colorectal Cancer

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Key Points

  • The Massachusetts health insurance expansion was associated with increased rates of resection for colorectal cancer.
  • The expansion was associated with a reduced likelihood of emergent resection.

In a study reported in the Journal of Clinical Oncology, Loehrer et al found that the 2006 Massachusetts health-care reform has resulted in increased rates of resection and reduced emergent resection for colorectal cancer.

The study used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer government-subsidized or self-pay or private insurance admitted to the hospital between 2001 and 2011 in Massachusetts (N = 17,499) and 3 control states (N = 144,253). The pre-reform period was defined as any discharge between the first quarter of 2001 and the second quarter of 2006. The post-reform period was defined as any discharge between the first quarter of 2008 and the fourth quarter of 2011.The effect of the 2006 coverage expansion on resection of colorectal cancer was analyzed, controlling for confounding factors and secular trends.

Changes in Resection Rate and Emergent Admission

Prior to the reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and control states. Compared with the control states, the Massachusetts reform was associated with a 15% increased rate of admission of government-subsidized or self-pay patients (incidence rate ratio [IRR] = 1.15, P < .001) and a 44% increased rate of resection (IRR = 1.44, P < .001) for admitted patients, including increased resection rates for colon cancer (IRR = 1.49, P < .001) and rectal cancer (IRR = 1.34, P = .021). Compared with the control states, coverage expansion was also associated with an adjusted absolute 6.21% decrease (P = .032) in the likelihood of emergent admission at the time of resection and an adjusted absolute 8.13% increase (P = .019) in the likelihood of elective admission at the time of resection.

The investigators concluded: “The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.”

The study was supported in part by the National Institute on Aging.

Andrew P. Loehrer, MD, MPH, of the Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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