Improved Health Insurance Access Increases Elective Colon Resection Rates

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci


November 16, 2017

Hello. I am David Kerr, professor of cancer medicine at the University of Oxford in England.

I have a deep and longstanding interest in colorectal cancer and also health policy. A lovely study by Andrew Loehrer and colleagues[1] from the Massachusetts General Hospital in Boston was published in December 2016 in the Journal of Clinical Oncology. These investigators looked at the impact of the 2006 Massachusetts health insurance expansion on a number of outcomes associated with colorectal cancer.

The study compared a large cohort of patients admitted for colorectal cancer care in Massachusetts with patients in three control states [that had not expanded health insurance coverage]: New York, New Jersey, and Florida. Investigators assessed three outcomes, including the rate of colon resections and the likelihood of patients presenting as an emergency or for an elective admission.

The study found that with the introduction of an expanded insurance program, there was a significant 8% increase in the number of patients receiving elective surgery and a 6% reduction in the number of patients admitted for emergency surgery, compared with patients in the control states. It also found a 44% increase in resection rates during this time. Previously, others had noted problems with each of these parameters [in uninsured patients],[2] and these problems were among the drivers behind introducing statewide insurance reform in Massachusetts, to reach out to those who were less able to pay for health insurance and health coverage.

These are important surrogate measures. It would have been lovely, of course, to see what was happening with more granular data. What about stage-related treatment? What about short-term outcomes, such as 30-day operative mortality, and longer-term outcomes, including recurrence rates and so on? Of course, we would love to be able to show that by investing in an expanded health insurance, people live longer and better. However, these surrogate measures can serve as proxies.

This is an interesting study. I would like to see more health policy being evidence-based in this way. In a way, this study was a natural experiment that shows that good can come of widening the orbit of citizens who have healthcare coverage.

Congratulations to these authors for this large study involving nearly 200,000 individuals, including cohorts and controls. The study was nicely conducted and very clearly analyzed. The authors were quite honest about the shortcomings I mentioned. But they have provided something for us all to think about, particularly during this time of relative political uncertainty as to where healthcare in the United States is going.

Thank you for listening. As always, I am keen for any comments that you may care to make. For now, Medscapers, over and out.


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