The Effect of Medicaid Expansion on Delivery of Finger and Thumb Replantation Care to Medicaid Beneficiaries and the Uninsured.
BACKGROUND
Despite advances in replantation, over 80 percent of finger and thumb amputation injuries in the United States result in revision amputation. Although numerous factors contribute to this, disparities in access and delivery of replantation care play a substantial role. With ongoing Medicaid expansion under the Affordable Care Act, it is prudent to understand whether expansion of coverage changes use of replantation care.


METHODS
The authors used the 2001 Medicaid expansion in New York State to evaluate changes in replantation for Medicaid beneficiaries and the uninsured. Data for patients having undergone replantation between 1998 and 2006 were obtained from the New York State Inpatient Database. The authors used an interrupted time series to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients underwent replantation. Census data were used for population-adjusted case volume analysis.


RESULTS
After expansion, the likelihood of Medicaid as the primary payer for replantation increased 0.0059 percent per quarter, reaching a 1.7 percent increase 5 years after expansion. With population-based analysis, this indicates that Medicaid covered 12 additional replantation cases in New York State annually. After expansion, 11 fewer of the replantation cases in New York State each year were provided to patients without health care coverage.


CONCLUSIONS
Medicaid expansion resulted in a modest but significant increase in replantation for Medicaid beneficiaries. In addition, fewer patients that underwent replantation remained uninsured. Considering the substantial cost and effort burden of replantation, these findings support the benefits of Medicaid expansion on delivery and payer coverage of replantation.
Ann Arbor, Mich. From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System; and the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School.
Aviram M
AM
Giladi
Oluseyi
O
Aliu
Kevin C
KC
Chung
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000601:surgery; D018737:Hand Strength; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York; D058991:Patient Protection and Affordable Care Act; D011379:Prognosis; D012092:Replantation / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013933:Thumb / Q000293:injuries; D014481:United States; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult