Who's being left behind? Uninsured emergency general surgery admissions after the ACA

Paul T Albini; Megan R Cochran-Yu; Laura N Godat; Todd W Costantini; Jay J Doucet

doi:10.1016/j.amjsurg.2019.10.005

Who's being left behind? Uninsured emergency general surgery admissions after the ACA

Am J Surg. 2019 Dec;218(6):1102-1109. doi: 10.1016/j.amjsurg.2019.10.005. Epub 2019 Oct 8.

Authors

Paul T Albini¹, Megan R Cochran-Yu², Laura N Godat³, Todd W Costantini⁴, Jay J Doucet⁵

Affiliations

¹ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, 92103, USA. Electronic address: ptalbini@ucsd.edu.
² Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, 92103, USA. Electronic address: mecochranyu@ucsd.edu.
³ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, 92103, USA. Electronic address: lgodat@ucsd.edu.
⁴ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, 92103, USA. Electronic address: tcostantini@ucsd.edu.
⁵ Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, 92103, USA. Electronic address: jdoucet@ucsd.edu.

PMID: 31607385
DOI: 10.1016/j.amjsurg.2019.10.005

Abstract

Background: The Affordable Care Act (ACA) increased Medicaid coverage of Emergency General Surgery (EGS). We hypothesized that despite the ACA, racial and geographic disparities persisted for EGS admissions.

Methods: The Nationwide Inpatient Sample was queried from 2012 through Q3 of 2015 for Non-Medicare patient EGS admissions. Difference-in-Differences analyses (DID) compared payors, complications, mortality and costs in pre-ACA years (2012-2013) and post-ACA years (2014-2015Q3).

Results: EGS cases fell 9.1% from 1,711,940 to 1,555,033 NIS-weighted cases. Hispanics were still most likely to be uninsured but had improved coverage (OR 0.92, 95% CI: 0.88-0.96, p < 0.001). Risk of uninsured EGS admissions from the South region persisted (OR 1.52, 95% CI: 1.46-1.58, p < 0.001). Uninsured EGS patients had higher DID increased mortality than insured patients (0.31% higher, P = 0.003). Insured group DID costs increased more rapidly than in self-pay Patients (6.0% higher, P = 0.008) CONCLUSIONS: Post ACA, risk of uninsured EGS admissions remained highest in the South, in males, and Hispanics.

Keywords: Affordable care act; Difference in differences; Emergency general surgery; Uninsured.

MeSH terms

Adult
Emergency Service, Hospital*
Female
General Surgery*
Hospital Costs
Hospital Mortality
Humans
Male
Medically Uninsured*
Patient Admission*
Patient Protection and Affordable Care Act
Retrospective Studies
United States