Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform

保险范围扩大对癌症治疗的影响：最近的政策变化以及对未来改革的影响

• 批准号: 10116048
• 负责人: Lindsay Marie Sabik
• 金额: $ 39.65万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10116048
• 关键词: Effects; Insurance; Expansions; Cancer; Treatment

PROJECT SUMMARY/ABSTRACT Cancer is among the most common causes of death and most costly diseases in the US, and timely access to high quality treatment is essential for minimizing cancer morbidity and mortality. Insurance coverage is an important determinant of access to care that contributes to documented disparities in outcomes. The Affordable Care Act (ACA) expanded access to insurance for non-elderly adults through subsidized Marketplace coverage and expansion of Medicaid to low-income adults in participating states. There is little evidence regarding the impact of insurance coverage expansions on access to or quality of cancer care. The proposed project will leverage variation in the timing of ACA provisions and changes in coverage under those provisions across geographic areas to estimate the impacts of insurance coverage expansions on cancer treatment. We use population-based data from Pennsylvania – the largest Medicaid expansion state that did not have extensive coverage for low-income adults prior to the ACA. Data come from the Pennsylvania state- wide cancer registry, along with data from all-payer inpatient, hospital outpatient, and ambulatory surgery center administrative files from the Pennsylvania Health Care Cost Containment Council (PHC4), linked to the registry at the individual level. The sample includes all non-elderly adult cancer patients in the state, with discharge information across all payers, including for uninsured patients. We use a quasi-experimental approach to estimate the effects of both private (Marketplace) and public (Medicaid) expansions on access to and quality of care for patients diagnosed with the four most common cancers (breast, prostate, lung and colorectal). Specifically, we examine the impact of insurance expansions on insurance coverage for cancer patients (Aim 1), access to cancer treatment (Aim 2), and quality of cancer care (Aim 3). We hypothesize that increases in coverage will be associated with shorter time from diagnosis to treatment; higher likelihood of treatment in accredited cancer centers, academic centers, and high-volume hospitals; increased receipt of guideline concordant care; and reductions in hospital readmission. All analysis will be stratified by cancer type, allowing for assessment of differential impacts across cancers, and we will assess the role of insurance coverage in reducing disparities in access for racial/ethnic minorities and rural populations. The project will provide detailed evidence on how the ACA affected insurance coverage, access, and quality of care for cancer patients, including the impact on existing disparities in care for underserved racial/ethnic minority and rural patients. A detailed understanding of the impacts of health insurance coverage expansions on care for cancer (among the most costly and deadly diseases in the US) will inform federal and state policymakers debating health reform proposals, program officials seeking evidence to guide development and implementation of coverage and care delivery policies, and researchers assessing ongoing policy changes and interventions to reduce disparities in cancer care.

项目摘要/摘要 癌症是美国最常见的死亡原因和最昂贵的疾病，并且及时获得 高质量的治疗对于最大程度地减少癌症的发病率和死亡率至关重要。保险范围是 重要的确定器可以促进成果中有记录的分布。这 通过补贴，负担得起的护理法案（ACA）扩大了非埃尔德利成人的保险访问权限 在参与州的低收入成年人的市场覆盖范围和扩展医疗补助。几乎没有 关于保险覆盖范围扩展对获得癌症护理质量或质量的影响的证据。 拟议的项目将利用ACA规定的时间和覆盖范围变化的变化 跨地理区域的规定估算保险覆盖范围扩展对癌症的影响 治疗。我们使用来自宾夕法尼亚州的基于人群的数据，这是最大的医疗补助扩张状态 在ACA之前，低收入成年人没有广泛的覆盖范围。数据来自宾夕法尼亚州 - 广泛的癌症注册表，以及来自全付住院医师，医院门诊和门诊手术的数据 宾夕法尼亚州医疗保健费用遏制委员会（PHC4）的中心行政档案 个人级别的注册表。该样本包括该州的所有非大型成年癌症患者， 在所有付款人中输送信息，包括未保险的患者。我们使用准实验 估算私人（市场）和公共（医疗补助）扩展对进入的影响的方法 和患有四种最常见癌症的患者的护理质量（乳房，前列腺，肺和 大肠）。特别是，我们研究了保险扩展对癌症保险保险的影响 患者（AIM 1），获得癌症治疗（AIM 2）和癌症护理质量（AIM 3）。我们假设这一点 覆盖范围的增加将与从诊断到治疗的时间较短；更高的可能性 在经认可的癌症中心，学术中心和大量医院进行治疗；收到的增加 指南协调；并减少医院再入院。所有分析将按癌症类型进行分层 允许评估各种癌症的差异影响，我们将评估保险的作用 减少种族/族裔少数民族和粗糙人口的差异的覆盖范围。该项目将 提供有关ACA如何影响癌症保险，获取和护理质量的详细证据 患者，包括对服务不足的种族/族裔少数民族和农村的现有分配的影响 患者。对健康保险覆盖范围扩展对癌症护理的影响的详细理解 （美国最昂贵，最致命的疾病）将告知联邦和州政策制定者辩论 卫生改革建议，计划官员寻求证据来指导发展和实施 覆盖范围和护理交付政策，以及评估正在进行的政策变更和干预措施的研究人员 减少癌症护理中的分布。