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Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act
A body of literature has previously highlighted the impact of health insurance on observed disparities in congenital cardiac operations. With aims of improving access to healthcare for all patients, the Affordable Care Act (ACA) expanded Medicaid coverage to nearly all eligible children in 2010. The...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10063518/ https://www.ncbi.nlm.nih.gov/pubmed/36906870 http://dx.doi.org/10.1007/s00246-023-03136-7 |
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author | Williamson, Catherine G. Park, Mina G. Mooney, Bailey Mantha, Aditya Verma, Arjun Benharash, Peyman |
author_facet | Williamson, Catherine G. Park, Mina G. Mooney, Bailey Mantha, Aditya Verma, Arjun Benharash, Peyman |
author_sort | Williamson, Catherine G. |
collection | PubMed |
description | A body of literature has previously highlighted the impact of health insurance on observed disparities in congenital cardiac operations. With aims of improving access to healthcare for all patients, the Affordable Care Act (ACA) expanded Medicaid coverage to nearly all eligible children in 2010. Therefore, the present population-based study aimed to examine the association of Medicaid coverage with clinical and financial outcomes in the era the ACA. Records for pediatric patients (≤ 18 years) who underwent congenital cardiac operations were abstracted from the 2010–2018 Nationwide Readmissions Database. Operations were stratified using the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Category. Multivariable regression models were developed to evaluate the association of insurance status on index mortality, 30-day readmissions, care fragmentation, and cumulative costs. Of an estimated 132,745 hospitalizations for congenital cardiac surgery from 2010 to 2018, 74,925 (56.4%) were insured by Medicaid. The proportion of Medicaid patients increased from 57.6 to 60.8% during the study period. On adjusted analysis, patients with Medicaid insurance were at an increased odds of mortality (1.35, 95%CI: 1.13–1.60) and 30-day unplanned readmission (1.12, 95%CI: 1.01–1.25), experienced longer lengths of stay (+ 6.5 days, 95%CI 3.7–9.3), and exhibited higher cumulative hospitalization costs (+ $21,600, 95%CI: $11,500–31,700). The total hospitalization cost-burden for patients with Medicaid and private insurance were $12.6 billion and $8.06 billion, respectively. Medicaid patients exhibited increased mortality, readmissions, care fragmentation, and costs compared to those with private insurance. Our results of outcome variation by insurance status indicate the necessity of policy changes to attempt to approach equality in surgical out comes for this high-risk cohort. GRAPHICAL ABSTRACT: Baseline characteristics, trends, and outcomes by insurance status over the ACA rollout period 2010–2018 [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00246-023-03136-7. |
format | Online Article Text |
id | pubmed-10063518 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-100635182023-04-01 Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act Williamson, Catherine G. Park, Mina G. Mooney, Bailey Mantha, Aditya Verma, Arjun Benharash, Peyman Pediatr Cardiol Research A body of literature has previously highlighted the impact of health insurance on observed disparities in congenital cardiac operations. With aims of improving access to healthcare for all patients, the Affordable Care Act (ACA) expanded Medicaid coverage to nearly all eligible children in 2010. Therefore, the present population-based study aimed to examine the association of Medicaid coverage with clinical and financial outcomes in the era the ACA. Records for pediatric patients (≤ 18 years) who underwent congenital cardiac operations were abstracted from the 2010–2018 Nationwide Readmissions Database. Operations were stratified using the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Category. Multivariable regression models were developed to evaluate the association of insurance status on index mortality, 30-day readmissions, care fragmentation, and cumulative costs. Of an estimated 132,745 hospitalizations for congenital cardiac surgery from 2010 to 2018, 74,925 (56.4%) were insured by Medicaid. The proportion of Medicaid patients increased from 57.6 to 60.8% during the study period. On adjusted analysis, patients with Medicaid insurance were at an increased odds of mortality (1.35, 95%CI: 1.13–1.60) and 30-day unplanned readmission (1.12, 95%CI: 1.01–1.25), experienced longer lengths of stay (+ 6.5 days, 95%CI 3.7–9.3), and exhibited higher cumulative hospitalization costs (+ $21,600, 95%CI: $11,500–31,700). The total hospitalization cost-burden for patients with Medicaid and private insurance were $12.6 billion and $8.06 billion, respectively. Medicaid patients exhibited increased mortality, readmissions, care fragmentation, and costs compared to those with private insurance. Our results of outcome variation by insurance status indicate the necessity of policy changes to attempt to approach equality in surgical out comes for this high-risk cohort. GRAPHICAL ABSTRACT: Baseline characteristics, trends, and outcomes by insurance status over the ACA rollout period 2010–2018 [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00246-023-03136-7. Springer US 2023-03-12 2023 /pmc/articles/PMC10063518/ /pubmed/36906870 http://dx.doi.org/10.1007/s00246-023-03136-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Williamson, Catherine G. Park, Mina G. Mooney, Bailey Mantha, Aditya Verma, Arjun Benharash, Peyman Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title | Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title_full | Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title_fullStr | Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title_full_unstemmed | Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title_short | Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act |
title_sort | insurance-based disparities in congenital cardiac operations in the era of the affordable care act |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10063518/ https://www.ncbi.nlm.nih.gov/pubmed/36906870 http://dx.doi.org/10.1007/s00246-023-03136-7 |
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