title: Health Insurance Expansion and Treatment of Pancreatic Cancer: Does Increased Access Lead to Improved Care?
abstract: BACKGROUND
  Pancreatic cancer is increasingly common and poised to become the second leading cause of cancer deaths by the year 2020. Surgical resection is the only chance for cure, yet significant disparities in resection rates exist by insurance status. The 2006 Massachusetts health care reform serves as natural experiment to evaluate the unknown impact of health insurance expansion on treatment of pancreatic cancer.
  
  
  METHODS
  Using the Agency for Healthcare Research and Quality's State Inpatient Databases, this cohort study examines nonelderly, adult patients with no insurance, private coverage, or government-subsidized insurance plans, who were admitted with pancreatic cancer in Massachusetts and 3 control states. The primary end point was change in pancreatic resection rates. Difference-in-difference models were used to show the impact of Massachusetts health care reform on resection rates for pancreatic cancer, controlling for confounding factors and secular trends.
  
  
  RESULTS
  Before the Massachusetts reform, government-subsidized and self-pay patients had significantly lower rates of resection than privately insured patients. The 2006 Massachusetts health reform was associated with a 15% increased rate of admission with pancreatic cancer (p = 0.043) and a 67% increased rate of surgical resection (p = 0.043) compared with control states. Measured disparities in likelihood of resection by insurance status decreased in Massachusetts and remained unchanged in control states.
  
  
  CONCLUSIONS
  The 2006 Massachusetts health care reform was associated with increased resection rates for pancreatic cancer compared with control states. Our findings provide hopeful evidence that increased insurance coverage can help improve equity in pancreatic cancer treatment. Additional studies are needed to evaluate the longevity of these findings and generalizability in other states.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: aloehrer@partners.org.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Loehrer
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hutter
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
mesh_terms: D015331:Cohort Studies; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000601:surgery*