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. 2015 Jul;262(1):139-45.
doi: 10.1097/SLA.0000000000000970.

Influence of Health Insurance Expansion on Disparities in the Treatment of Acute Cholecystitis

Andrew P Loehrer  1 , Zirui Song, Hugh G Auchincloss, Matthew M Hutter
Affiliations

Influence of Health Insurance Expansion on Disparities in the Treatment of Acute Cholecystitis

Andrew P Loehrer et al. Ann Surg. 2015 Jul.

Abstract

Objective: To evaluate the impact of the 2006 Massachusetts (MA) health reform on disparities in the management of acute cholecystitis (AC).

Background: Immediate cholecystectomy has been shown to be the optimal treatment for AC, yet variation in care persists depending upon insurance status and patient race. How increased insurance coverage impacts these disparities in surgical care is not known.

Methods: A cohort study of patients admitted with AC in MA and 3 control states from 2001 through 2009 was performed using the Hospital Cost and Utilization Project State Inpatient Databases. We examined all nonelderly white, black, or Latino patients by insurance type and patient race, evaluating changes in the probability of undergoing immediate cholecystectomy and disparities in receiving immediate cholecystectomy before and after Massachusetts health reform.

Results: Data from 141,344 patients hospitalized for AC were analyzed. Before the 2006 reform, government-subsidized/self-pay (GS/SP) patients had a 6.6 to 9.9 percentage-point lower (P < 0.001) probability of immediate cholecystectomy in both MA control states. The MA insurance expansion was independently associated with a 2.5 percentage-point increased probability of immediate cholecystectomy for all GS/SP patients in MA (P = 0.049) and a 5.0 percentage-point increased probability (P = 0.011) for nonwhite, GS/SP patients compared to control states. Racial disparities in the probability of immediate cholecystectomy seen before health care reform were no longer statistically significant after reform in MA while persisting in control states.

Conclusions: The MA health reform was associated with increased probability of undergoing immediate cholecystectomy for AC and reduced disparities in undergoing cholecystectomy by insurance status and patient race.

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Figures

Figure 1
Figure 1
Unadjusted trends in cholecystectomy for AC by insurance status in a) Massachusetts and b) control states * Implementation of Massachusetts Insurance Expansion AC Acute cholecystitis PVT Private insurance coverage GS/SP Government-subsidized/self-pay coverage
Figure 1
Figure 1
Unadjusted trends in cholecystectomy for AC by insurance status in a) Massachusetts and b) control states * Implementation of Massachusetts Insurance Expansion AC Acute cholecystitis PVT Private insurance coverage GS/SP Government-subsidized/self-pay coverage
Figure 2
Figure 2
Effect of being government-subsidized/self-pay patient on the probability of receiving immediate cholecystectomy * Absolute difference in probability of receiving a cholecystectomy between government-subsidized/self-pay and privately insured patients, controlling for patient age, sex, race, comorbidities, hospital type, admission type, and complicated presentation.
Figure 3
Figure 3
Unadjusted trends in immediate cholecystectomy for AC in GS/SP patients by patient race in a) Massachusetts and b) control states * Implementation of Massachusetts Insurance Expansion AC Acute cholecystitis W White patients NW Non-white patients
Figure 3
Figure 3
Unadjusted trends in immediate cholecystectomy for AC in GS/SP patients by patient race in a) Massachusetts and b) control states * Implementation of Massachusetts Insurance Expansion AC Acute cholecystitis W White patients NW Non-white patients
Figure 4
Figure 4
Effect of non-white race on probability of receiving immediate cholecystectomy * Absolute difference in probability of receiving a cholecystectomy between government-subsidized/self-pay non-white and white patients, controlling for age, sex, comorbidities, hospital type, admission type, and complicated presentation.
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