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How Obamacare will increase inpatient surgery rates

Teresa Tanoos's picture
New study explores how Obamacare will affect rates of inpatient surgery

Obamacare has had its share of naysayers, especially since the disastrous debut of the online exchanges at HealthCare.gov last October.

But supporters of the Affordable Care Act, including President Obama, keep telling Americans to give it a chance – because once the health law is fully implemented, it’s supposed to cover some 25 million people who previously could not afford health insurance.

To that end, the government provided additional funding to some states earlier this year to expand Medicaid in an effort to help even more low-income adults under the age of 65 obtain health coverage.

While providing low-income Americans with access to health care is what Obamacare strives to do – and that the expansion of Medicaid programs helps to accomplish – researchers from the University of Michigan wanted to find out how all this will affect rates for expensive and complex hospital care, including inpatient surgery.

They therefore launched a study, which has since been published in JAMA Surgery, using the 2006 health care reform act in Massachusetts for estimating the impact of Obamacare on future inpatient surgeries in the United States.

For the study, researchers analyzed inpatient databases in Massachusetts over a period of 7 years, starting January 1, 2003 through January 1, 2010. In addition, the team examined information from inpatient databases in New Jersey and New York during that same period, using the two states as controls.

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The researchers specifically wanted to find out how many patients between the ages of 19 and 64 had undergone elective surgical procedures (e.g. back surgery, joint replacements, etc.), and how many had undergone required procedures, such as surgery for cancer or heart disease.

As a result, they discovered that there were 836,311 total surgeries performed during those 7 years, with 22.2 percent of them occurring in Massachusetts; 54.7 percent in New York; and 22.9 percent in New Jersey.

They also found that insurance expansion in Massachusetts was linked to an increase in elective surgical procedures of 9.3 percent – and a decrease in non-elective (or required) surgeries of 4.5 percent.

Using these figures, the researchers were able to calculate that an estimated 465,934 extra elective surgeries could be performed by the year 2017.

The team emphasized that these figures are just estimates and subject to limitation, admitting that it would be impossible to know with any certainty if a procedure was elective or not.

They also admitted that using the 2006 Massachusetts health care reform act for predicting the impact of Obamacare on hospital-based care, such as inpatient surgery, may be problematic since it was launched in 2006 under different circumstances.

Nevertheless, they said that using the Massachusetts health care act was “the most reasonable natural experiment of broad insurance expansion”, citing that it has been used previously and often to predict the future impact of Obamacare.

SOURCE: Effect of Insurance Expansion on Utilization of Inpatient Surgery, doi:10.1001/jamasurg.2014.857, Chandy Ellimoottil et al., published in JAMA Surgery, 2 July 2014.