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Association of Affordable Care Act-related Medicaid expansion with variation in utilization of surgical services

  • Tyler R. McClintock
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Harvard Business School, Boston, MA, USA
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  • Suhas Gondi
    Affiliations
    Harvard Medical School, Boston, MA, USA
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  • Ye Wang
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • David F. Friedlander
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Alexander P. Cole
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Maxine Sun
    Affiliations
    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Nelya Melnitchouk
    Affiliations
    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Steven L. Chang
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Adil H. Haider
    Affiliations
    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Joel S. Weissman
    Affiliations
    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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  • Quoc-Dien Trinh
    Correspondence
    Corresponding author. Brigham and Women’s Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA.
    Affiliations
    Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
Published:December 28, 2019DOI:https://doi.org/10.1016/j.amjsurg.2019.12.017

      Highlights

      • We found a smaller decrease in surgical utilization in a population with Affordable Care Act-related Medicaid expansion compared to one without.
      • The divergence of trends in this study was driven by increased utilization of discretionary surgery.
      • We observed an increase in Medicaid coverage among patients undergoing surgery.

      Abstract

      Background

      We aim to understand how Medicaid expansion under the ACA has affected utilization of surgical services.

      Methods

      The State Inpatient Databases were used to compare utilization of a broad array of surgical procedures among nonelderly adults (aged 19–64 years) in a multistate population that experienced ACA-related Medicaid expansion to one that did not. We performed a difference-in-differences (DID) analysis to determine the effect of Medicaid expansion on utilization of surgical services from 2012 to 2014.

      Results

      There were 259,061 cases identified in the Medicaid expansion population and 261,269 in the control population. In the expansion group, there was a smaller decrease in utilization - by a margin of 21.68 cases per 100,000 individuals (p < 0.001). Percent of surgical patients covered by Medicaid increased among the expansion group from 12.00% to 15.48% (DID = 3.93%; p < 0.001).

      Conclusions

      Year one of Medicaid expansion under the ACA was associated with a modest but statistically significant difference in utilization of surgical services as well as an increase in percent of surgery patients covered by Medicaid.

      Keywords

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