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Massachusetts Healthcare Reform and Trends in Emergent Colorectal Surgery
Mariam F. Eskander1, Lindsay A. Bliss1, Ellen P. McCarthy1, Susanna W. de Geus1, Sing Chau Ng1, James R. Rodrigue1, Jennifer F. Tseng1
1Beth Israel Deaconess Medical Center, Boston, MA, USA

Background: Insurance impacts access to therapeutic options yet little is known how healthcare reform might change the pattern of surgical admissions. We compared rates of emergent versus elective admissions for colectomy before and after reform in Massachusetts (MA.)

Methods: Patients 18-64 with public or no insurance who underwent emergent vs. elective inpatient colectomy (via ICD-9 procedural code) from 2002-2012 in the MA Healthcare Cost and Utilization Project (HCUP) State Inpatient Database and from 2002-2011 in the Nationwide Inpatient Sample (NIS) were compared. Medicare patients were excluded. Pre-reform was defined as hospital discharge from 2002 through the 2nd quarter of 2006 and post-reform from the 3rd quarter of 2006 through 2012. Unadjusted categorical variables compared by chi square. Piecewise functions used to test the effect of healthcare reform on the rate of emergent surgeries.

Results: Unadjusted rate of emergent colectomies was lower in MA after reform but did not change nationally over same time period (Table 1.) For emergent surgeries in MA, a piecewise model with an inflection point (peak) in the 3rd quarter of 2006, coinciding with implementation of healthcare reform in MA, had a lower mean squared error than a linear model. In comparison, the U.S. rate of emergent surgeries demonstrated no change in pattern.

Conclusion: There was a unique and sustained decline in the rate of emergent colon resection among publically insured and uninsured patients after 2006 in MA, in contradistinction to U.S. national pattern, suggesting improved access to care associated with health insurance expansion.


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