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The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.
- Author(s): Dawes, Aaron J;
- Louie, Rachel;
- Nguyen, David K;
- Maggard-Gibbons, Melinda;
- Parikh, Punam;
- Ettner, Susan L;
- Ko, Clifford Y;
- Zingmond, David S
- et al.
Published Web Locationhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254125/
ObjectiveTo examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians.
Data sourcesCalifornia Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008.
Study designWe linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables.
Data collection/extraction methodsAll incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment.
Principal findingsContinuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment.
ConclusionsExpansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California.
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