Access to healthcare insurance increases the rates of surgery for diverticulitis

ABSTRACT

Objective: The goal of this study was to examine the effect of the Affordable Care Act Medicaid expansion on rates of hospitalization and surgery for diverticulitis.

Study Settings: Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Databases from 2010 to 2014.

Study Design: Retrospective cohort study analyzing adult patients undergoing surgery for diverticulitis in the expansion and nonexpansion states, pre (2010-2013) and post (2014) Medicaid expansion.

Findings: There were a total of 159,419 patients in our cohort analysis. 75,575 (49%) in expansion states and 81,844 (51%) in non-expansion states. In multivariable Poisson regression, the rate of surgical procedures for diverticular disease increased among Medicaid patients (IRR 1.80; p < .01) whereas surgery rates in self-pay patients decreased (IRR 0.67; p < .01) in expansion states compared to non-expansion states.

Conclusions: In states that expanded Medicaid coverage under the Affordable Care Act, the rate of surgery for diverticular disease in Medicaid patients increased. Therefore, legislation that increases healthcare access may increase the utilization of surgical care for diverticular disease.

KEYWORDS:

• Medicaid expansion
• Affordable care Act
• Colorectal surgery
• Diverticulitis

Acknowledgements

The author thanks Paul C. Kuo and Patrick Sweigert, for there assistance with this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Meeting presentation

Presented as an oral podium presentation at the American Society of Colon and Rectal Surgeons conference on June 1-5, 2019, in Cleveland, OH

Additional information

Funding

This work is supported by the National Institute of Health 5 T32 GM008750-18 (EE).

Notes on contributors

Emanuel Eguia

Conceptualization, EE, JE, and TC. Acquisition of data, EE and JE. Analysis, EE, JE, TC, MC, and MS. Interpretation of data, EE, JE, TC, MC, and MS. Drafting the article, EE, JE, TC, MC and MS. Final approval of the manuscript, EE, JE, TC, MC, and MS.

Timothy Classen

Conceptualization, EE, JE, and TC. Acquisition of data, EE and JE. Analysis, EE, JE, TC, MC, and MS. Interpretation of data, EE, JE, TC, MC, and MS. Drafting the article, EE, JE, TC, MC and MS. Final approval of the manuscript, EE, JE, TC, MC, and MS.

Mashkoor Choudhry

Conceptualization, EE, JE, and TC. Acquisition of data, EE and JE. Analysis, EE, JE, TC, MC, and MS. Interpretation of data, EE, JE, TC, MC, and MS. Drafting the article, EE, JE, TC, MC and MS. Final approval of the manuscript, EE, JE, TC, MC, and MS.

Marc Singer

Conceptualization, EE, JE, and TC. Acquisition of data, EE and JE. Analysis, EE, JE, TC, MC, and MS. Interpretation of data, EE, JE, TC, MC, and MS. Drafting the article, EE, JE, TC, MC and MS. Final approval of the manuscript, EE, JE, TC, MC, and MS.

Joshua Eberhardt

Conceptualization, EE, JE, and TC. Acquisition of data, EE and JE. Analysis, EE, JE, TC, MC, and MS. Interpretation of data, EE, JE, TC, MC, and MS. Drafting the article, EE, JE, TC, MC and MS. Final approval of the manuscript, EE, JE, TC, MC, and MS.