title: Effects of state-level medicaid policies and patient characteristics on time to breast cancer surgery among medicaid beneficiaries.
abstract: Medicaid beneficiaries with cancer are less likely to receive timely and high-quality care. This study examined whether differences in state-level Medicaid policies affect delays in time to surgery (TTS) among women diagnosed with breast cancer. Using 2006-2008 Medicaid data, we identified women aged 18-64 enrolled in Medicaid diagnosed with breast cancer. Analyses examined associations of state-specific Medicaid surgery reimbursements, Medicaid eligibility recertification period (annually vs. shorter) and required patient copayment on time from breast cancer diagnosis to receipt of breast surgery. Patients receiving neoadjuvant therapy were excluded. Separate multivariable regression analyses controlling for patient demographic characteristics and clustering by state were performed for breast conserving surgery (BCS), inpatient mastectomy, and outpatient mastectomy. The study included 7542 Medicaid beneficiaries with breast cancer: 3272 received BCS, 2156 outpatient mastectomy, and 2115 inpatient mastectomy. Higher Medicaid reimbursements for BCS were associated with decreased time from diagnosis to surgery. A 12-month (vs. <12 month) Medicaid eligibility recertification period was associated with decreased TTS for BCS and outpatient mastectomy. Black Medicaid beneficiaries (compared with non-Hispanic White beneficiaries) were more likely to experience delays for all three types of surgery, while Hispanic beneficiaries were more likely to experience delays only for outpatient mastectomy. State-level Medicaid policies and patient characteristics can affect receipt of timely surgery among Medicaid beneficiaries with breast cancer. As delays in surgery can increase morbidity and mortality, changes to state Medicaid policies and health system programs are needed to improve access to care for this vulnerable population.
authors.affiliation: RTI International, Washington, DC, USA. michael.halpern@temple.edu.|Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave. # 533, Philadelphia, PA, 19122, USA. michael.halpern@temple.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Halpern
authors.affiliation: Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D008484:Medicaid / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D012044:Regression Analysis; D013221:State Health Plans; D061665:Time-to-Treatment / Q000331:legislation & jurisprudence*; D014481:United States / Q000208:ethnology; D055815:Young Adult
keywords: Breast conserving surgery; Breast neoplasms; Mastectomy; Medicaid; Time factors