Insurance Coverage Type Impacts Hospitalization Patterns Among Patients with Hepatopancreatic Malignancies

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2019 Jun 15

PMID 31197689

Citations 1

Authors

Rittal Mehta

Kota Sahara

Katiuscha Merath

J Madison Hyer

Diamantis I Tsilimigras

Anghela Z Paredes

Aslam Ejaz

Jordan M Cloyd

Mary Dillhoff

Allan Tsung

Timothy M Pawlik

Affiliations

Soon will be listed here.

Abstract

Introduction: Disparities in health and healthcare access remain a major problem in the USA. The current study sought to investigate the relationship between patient insurance status and hospital selection for surgical care.

Methods: Patients who underwent liver or pancreatic resection for cancer between 2004 and 2014 were identified in the National Inpatient Sample. The association of insurance status and hospital type was examined.

Results: In total, 22,254 patients were included in the study. Compared with patients with private insurance, Medicaid patients were less likely to undergo surgery at urban non-teaching hospitals (OR = 0.36, 95%CI 0.22-0.59) and urban teaching hospitals (OR = 0.54, 95%CI 0.34-0.84) than rural hospitals. Medicaid patients were less likely to undergo surgery at private investor-owned hospitals (OR = 0.53, 95%CI 0.38-0.73) than private non-profit hospitals. In contrast, uninsured patients were 2.2-fold more likely to go to government-funded hospitals rather than private non-profit hospitals (OR = 2.19, 95%CI 1.76-2.71).

Conclusion: Insurance status was strongly associated with the type of hospital in which patients underwent surgery for liver and pancreatic cancers. Addressing the reasons for inequitable access to different hospital settings relative to insurance status is essential to ensure that all patients undergoing pancreatic or liver surgery receive high-quality surgical care.

Citing Articles

Availability of laparoscopic surgery in Mexico's public health system: a nationwide retrospective analysis.

Bryce-Alberti M, Campos L, Dey T, Del Valle D, Hill S, Zaigham M Lancet Reg Health Am. 2023; 24:100556.

PMID: 37521438 PMC: 10372900. DOI: 10.1016/j.lana.2023.100556.

References

Chen A, Schrag N, Halpern M, Ward E . The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. Cancer. 2007; 110(2):395-402. DOI: 10.1002/cncr.22788. View

Chen A, Schrag N, Halpern M, Stewart A, Ward E . Health insurance and stage at diagnosis of laryngeal cancer: does insurance type predict stage at diagnosis?. Arch Otolaryngol Head Neck Surg. 2007; 133(8):784-90. DOI: 10.1001/archotol.133.8.784. View

Roetzheim R, Pal N, Gonzalez E, Ferrante J, van Durme D, Krischer J . Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health. 2000; 90(11):1746-54. PMC: 1446414. DOI: 10.2105/ajph.90.11.1746. View

Merath K, Chen Q, Bagante F, Sun S, Akgul O, Idrees J . Variation in the cost-of-rescue among medicare patients with complications following hepatopancreatic surgery. HPB (Oxford). 2018; 21(3):310-318. DOI: 10.1016/j.hpb.2018.08.005. View

Okunrintemi V, Khera R, Spatz E, Salami J, Valero-Elizondo J, Warraich H . Association of Income Disparities with Patient-Reported Healthcare Experience. J Gen Intern Med. 2019; 34(6):884-892. PMC: 6544715. DOI: 10.1007/s11606-019-04848-4. View

Frieden T . CDC Health Disparities and Inequalities Report - United States, 2013. Foreword. MMWR Suppl. 2013; 62(3):1-2. View

Kneuertz P, Pitt H, Bilimoria K, Smiley J, Cohen M, Ko C . Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg. 2012; 16(9):1727-35. DOI: 10.1007/s11605-012-1938-y. View

Merath K, Chen Q, Johnson M, Mehta R, Beal E, Dillhoff M . Hot spotting surgical patients undergoing hepatopancreatic procedures. HPB (Oxford). 2018; 21(6):765-772. DOI: 10.1016/j.hpb.2018.10.011. View

Zak Y, Rhoads K, Visser B . Predictors of surgical intervention for hepatocellular carcinoma: race, socioeconomic status, and hospital type. Arch Surg. 2011; 146(7):778-84. DOI: 10.1001/archsurg.2011.37. View

10.

Merath K, Bagante F, Chen Q, Beal E, Akgul O, Idrees J . The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis. J Gastrointest Surg. 2018; 22(9):1538-1548. DOI: 10.1007/s11605-018-3783-0. View

11.

Niu X, Roche L, Pawlish K, Henry K . Cancer survival disparities by health insurance status. Cancer Med. 2013; 2(3):403-11. PMC: 3699851. DOI: 10.1002/cam4.84. View

12.

Amini N, Kim Y, Hyder O, Spolverato G, Wu C, Page A . A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery. Am J Surg. 2015; 210(3):483-91. PMC: 4695995. DOI: 10.1016/j.amjsurg.2015.04.009. View

13.

Bhattacharyya N, Abemayor E . Patterns of hospital utilization for head and neck cancer care: changing demographics. JAMA Otolaryngol Head Neck Surg. 2015; 141(4):307-12. DOI: 10.1001/jamaoto.2014.3603. View

14.

Gruber K, Soliman A, Schmid K, Rettig B, Ryan J, Watanabe-Galloway S . Disparities in the Utilization of Laparoscopic Surgery for Colon Cancer in Rural Nebraska: A Call for Placement and Training of Rural General Surgeons. J Rural Health. 2015; 31(4):392-400. PMC: 4592370. DOI: 10.1111/jrh.12120. View

15.

Armenia S, Pentakota S, Merchant A . Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period. J Surg Res. 2017; 212:178-186. DOI: 10.1016/j.jss.2017.01.015. View

16.

Nathan H, Jong M, Pulitano C, Ribero D, Strub J, Mentha G . Conditional survival after surgical resection of colorectal liver metastasis: an international multi-institutional analysis of 949 patients. J Am Coll Surg. 2010; 210(5):755-64, 764-6. DOI: 10.1016/j.jamcollsurg.2009.12.041. View

17.

Nathan H, Frederick W, Choti M, Schulick R, Pawlik T . Racial disparity in surgical mortality after major hepatectomy. J Am Coll Surg. 2008; 207(3):312-9. PMC: 4217642. DOI: 10.1016/j.jamcollsurg.2008.04.015. View

18.

Ho V, Nash G, Feldman E, Trencheva K, Milsom J, Lee S . Insurance but not race is associated with diverticulitis mortality in a statewide database. Dis Colon Rectum. 2011; 54(5):559-65. DOI: 10.1007/DCR.0b013e31820d188f. View

19.

Abraham A, Al-Refaie W, Parsons H, Dudeja V, Vickers S, Habermann E . Disparities in pancreas cancer care. Ann Surg Oncol. 2013; 20(6):2078-87. DOI: 10.1245/s10434-012-2843-z. View

20.

Dimick J, Cowan Jr J, Colletti L, Upchurch Jr G . Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg. 2004; 139(2):137-41. DOI: 10.1001/archsurg.139.2.137. View