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. 2021 Aug;222(2):256-261.
doi: 10.1016/j.amjsurg.2021.01.041. Epub 2021 Feb 4.

The impact of the affordable care act on surgeon selection amongst colorectal surgery patients

Jason Tong  1 , Ezra S Brooks  2 , Catherine L Mavroudis  3 , Christopher Wirtalla  3 , Cary B Aarons  4 , Nicole M Saur  4 , Najjia N Mahmoud  4 , Giorgos C Karakousis  3 , Rachel R Kelz  3
Affiliations

The impact of the affordable care act on surgeon selection amongst colorectal surgery patients

Jason Tong et al. Am J Surg. 2021 Aug.

Abstract

Background: It is unclear how the Affordable Care Act's state-based Medicaid Expansion (ME) has impacted surgeon selection for colorectal resections (CRS).

Methods: We performed a risk-adjusted DID analysis on state discharge data of CRS patients aged 26-64 from NY (Expansion) and FL (non-Expansion) before (2012-2013) and after (2016-2017) ME. Primary outcome was use of a high-volume or colorectal-boarded surgeon. Subset analysis performed on insurance status.

Results: Among 78,866 CRS patients, ME was associated with a 5.9% increase in Medicaid enrollment. ME was associated with a 0.73 (95%CI: 0.67-0.69; p < 0.001) reduced odds of high-volume surgeon usage by commercially insured patients when compared to usage by commercially insured patients in the non-expansion state. No statistically significant difference was noted in the use of a colorectal-boarded surgeon following reform.

Conclusions: ME was associated with an increase in Medicaid enrollment and a decrease in the use of high-volume surgeons by the commercially insured.

Keywords: Colon surgery; Health disparity; Health inequities; Rectal surgery; Socioeconomic health disparity.

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Conflict of interest statement

Declaration of competing interest The authors have no financial conflicts of interest to declare.

Comment in

  • The Affordable Care Act: A success?
    Williams JL, Shaffer VO. Williams JL, et al. Am J Surg. 2021 Aug;222(2):254-255. doi: 10.1016/j.amjsurg.2021.02.001. Epub 2021 Feb 14. Am J Surg. 2021. PMID: 33612259 No abstract available.

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