Early impact of new health care legislation on the pediatric surgical experience of surgical residents.
On January 1, 1994, Tennessee implemented TennCare, an insurance program for the state's medically uninsured and those who were previously covered by Medicaid. To determine how this change has affected the pediatric surgical experience of residents in training, we reviewed our institution's operative case logs from the first quarter of 1994 and compared them with logs for the first quarter of the years 1990 through 1993. Cases were classified according to urgency and necessity of surgical procedures. No significant change was noted in the number of patients having operations for the most necessary or urgent conditions, such as solid tumors or appendicitis. In contrast, the number of elective operations, principally for hernias, decreased significantly during the same period. While Tennessee's legislative change apparently has not affected the volume of urgent surgical cases, it has significantly decreased surgical residents' elective pediatric surgical experience.
Smith
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Department of Surgery, University of Tennessee, Memphis, USA.
Lobe
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D001064:Appendicitis / Q000601:surgery; D002648:Child; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D013502:General Surgery / Q000193:education*; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D059685:Herniorrhaphy; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D007396:Internship and Residency / Q000706:statistics & numerical data; D008484:Medicaid / Q000331:legislation & jurisprudence; D017057:Medically Uninsured / Q000331:legislation & jurisprudence; D009369:Neoplasms / Q000601:surgery; D010372:Pediatrics / Q000193:education* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D014481:United States