Medicaid is the principal source of subsidy for therapeutic and health-related facilities in the United States for individuals with low income. In 2014, President Obama signed the Affordable Care Act (ACA) to make health protection more reasonably priced for them. Thus, Medicaid Expansion addressed the health disparities originating from poor or no insurance.
A recent article published in the Journal of Surgical Research estimated the incidence and fatality rate of ambulatory and emergency cholecystectomies in New Jersey. This article sheds light on whether the Medicaid expansion transformed cholecystectomy trends.
Cholecystectomy is a common treatment for gallstones and gallbladder conditions. Approximately 600 thousand individuals undergo this practice each year in the United States. A previous study about uninsured and Medicaid-covered U.S. hospitalizations stated that cholecystectomy was the most common surgical procedure in 2012. However, there are limited data on the longitudinal trends of this medical intervention and its consequences.
Gregory and collaborators designed a retrospective population cohort to investigate the occurrence of cholecystectomy and its fatality rate in the US, from 2009 to 2018. They postulated that the 2014 Medicaid expansion would decrease emergency cholecystectomies, increase ambulatory practices – any action happening outside of the hospital – and not affect the fatality rates.
Results
Matching their expectation, the researchers identified a noticeable reduction in the incidence of emergency cholecystectomies. Largely, almost 10 thousand (93.423) emergency cholecystectomies had been performed across the hospitals, with 644 fatalities. In contrast, they identified 87.239 cases of ambulatory cholecystectomies, with less than 10 fatalities.
Emergency cholecystectomies’ annual occurrence plummeted remarkably from 114.8 to 77.5 per 100.000 population in New Jersey, from 2009 to 2018. Whilst ambulatory cholecystectomies rose from 93.5 to 95.6 per 100.000 population, which was in line with the study hypothesis.
Medicaid expansion decreased the rate of uninsured individuals by 42% in New Jersey. Therefore, the subsequent greater than-before access to healthcare facilities likely made appropriate interventions possible for people with gallstone diseases. In other words, greater ambulatory cholecystectomies contributed to lesser emergency cholecystectomies, and, thus, fewer surgery-related deaths.
The cases of emergency cholecystectomies plunged after the Medicaid expansion. Moreover, Gregory and the team identified a decrease in fatality among people aged over 65 years undergoing emergency cholecystectomies after the Medicaid expansion. However, this reduction was not elucidated by health insurance.
The researchers mentioned that these trends are influenced by Medicaid expansion. This policy allowed public health intermediation for thousands of additional people.
The strongest key of this research was the inclusion of data on all entitled patients in a distinct population before and after the expansion. Nevertheless, the team emphasized the need for more studies to acknowledge other interventions that may improve the overall incidence of gallstone diseases and reduce mortality.
References
Peck, G. L., Kuo, Y. H., Hudson, S. V., Gracias, V. H., Roy, J. A., & Strom, B. L. (2023). Decreased Emergency Cholecystectomy and Case Fatality Rate, Not Explained by Expansion of Medicaid. journal of surgical research, 288, 350-361. https://doi.org/10.1016/j.jss.2023.03.006
Lopez-Gonzalez, L., Pickens, G. T., Washington, R., & Weiss, A. J. (2014). Characteristics of Medicaid and uninsured hospitalizations, 2012.
Sommers, B. D., Arntson, E., Kenney, G. M., & Epstein, A. M. (2013). Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials. Medicare & Medicaid research review, 3(4). https://doi.org/10.5600%2Fmmrr.003.04.a02
Ambur, V., Taghavi, S., Kadakia, S., Jayarajan, S., Gaughan, J., Sjoholm, L. O., … & Goldberg, A. J. (2017). Does socioeconomic status predict outcomes after cholecystectomy?. The American Journal of Surgery, 213(1), 100-104. https://doi.org/10.1016/j.amjsurg.2016.04.012
Kocher, R., Emanuel, E. J., & DeParle, N. A. M. (2010). The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Annals of internal medicine, 153(8), 536-539. https://doi.org/10.7326/0003-4819-153-8-201010190-00274
