title: No survival benefit to gaining private health insurance coverage for post-lung transplant care in adults with cystic fibrosis.
abstract: The use of public insurance is associated with diminished survival in patients with cystic fibrosis (CF) following lung transplantation. No data exist on benefits of gaining private health insurance for post-transplant care among such patients previously using public insurance. The United Network for Organ Sharing database was used to identify first-time lung transplant recipients participating in Medicare or Medicaid, diagnosed with CF, and transplanted between 2005 and 2015. Survival outcomes were compared between recipients gaining private insurance after transplantation and those maintaining public coverage throughout follow-up. Since implementation of the lung allocation score, 575 adults with CF received lung transplantation funded by Medicare or Medicaid and contributed data on insurance status post-transplant. There were 128 (22%) patients who gained private insurance. Multivariable analysis of time-varying insurance status found no survival benefit of gaining private insurance (HR = 0.822; 95% CI = 0.525, 1.286; p = 0.390). Further analysis demonstrated that resuming public insurance coverage was detrimental, relative to gaining and keeping private insurance (HR = 2.315; 95% CI = 1.020, 5.258; p = 0.045). Survival disadvantages of lung transplant recipients with CF who have public health insurance were not ameliorated by a switch to private coverage for post-transplant care.
authors.affiliation: Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.|Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.|Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.|Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000191:economics / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000191:economics / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D016040:Lung Transplantation / Q000191:economics / Q000401:mortality*; D008297:Male; D017149:Private Sector / Q000458:organization & administration*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014481:United States
keywords: UNOS; cystic fibrosis; health insurance; lung transplantation; survival