The Lynx Group

Insurance Status Impacts Ability to Travel for Care

April 2015, Vol 6, No 3

Orlando, FL—Patients undergoing complex oncologic procedures, such as rad­ical cystectomy, radical prostatectomy, or percutaneous nephrolithotomy, are more likely to travel outside of their regions if they have private insurance, potentially reflecting better access to care based on income, according to findings presented at the 2015 Genitourinary Cancers Symposium.

“Through the Affordable Care Act, insurance coverage is increasing, with financial incentives for primary care providers,” noted lead investigator Matthew Mossanen, MD, of the Department of Urology, University of Washington, ­Seattle. “However, many subspecialty fields, like urology, lack monetary motivation caring for newly insured patients.”

“An influx of new patients may potentially be challenged by a lack of access to subspecialty services that is not necessarily improved under the new system,” stated Dr Mossanen.

Dr Mossanen’s study sought to examine the potential impact of these healthcare changes on the travel for care based on insurance type for urologic procedures.

Included in the analysis were the following procedures—radical cystectomy, radical prostatectomy, transurethral resection of prostate, shockwave lithotripsy, nephrectomy, percutaneous nephrolithotomy, retroperitoneal lymph node dissection, and pyeloplasty.

Patients were grouped into 1 of 4 insurance types—Medicaid, Medicare, private/HMO, and other (charity care).

Hospital service areas were defined as areas where the majority of local patients are hospitalized, and hospital referral regions were defined as where most patients received tertiary care.

According to data collected between 2011 and 2012, 600 Medicaid patients, 3806 Medicare beneficiaries, 4998 patients with private insurance, and 554 patients with other insurance underwent urologic surgery in Washington State.

Dr Mossanen emphasized the following results:

  • Of Medicaid patients undergoing radical cystectomy, 13.3% left their region for care versus 29.9% for Medicare beneficiaries and 39.8% for private insurance
  • Similarly, 10.8% of radical prostatectomy patients with Medicaid coverage traveled outside of their region for care versus 19.5% for Medicare beneficiaries and 24.6% for private insurance
  • Of patients with private insurance undergoing percutaneous nephrolithotomy, 21.9% traveled outside of their region versus only 12% of Medicare beneficiaries and 17.2% of Medicaid patients
  • Nonwhite patients are significantly less likely to travel to an outside hospital (odds ratio, 0.66; P <.001)
  • Patients with increased comorbidities are significantly less likely to travel to an outside hospital.
“As the Affordable Care Act takes effect,” concluded Dr Mossanen, “attention to access to subspecialty care is critical and may help inform quality improvement initiatives designed to promote greater access to urologic surgery.”

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