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The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care

  • Global Health Services Research
  • Published:
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Abstract

Introduction

The impact of Medicaid expansion (ME) on hepatocellular carcinoma (HCC) remains controversial, and heterogeneous effects on care processes may relate to sociodemographic factors. We sought to evaluate the association between ME and receipt of surgery in early-stage HCC.

Methods

Patients diagnosed with early-stage HCC between 40 and 64 years of age were identified from the National Cancer Database and divided into pre‐ (2004–2012) and post‐ (2015–2017) expansion cohorts. Logistic regression was used to identify predictors of surgical treatment. Difference-in-difference (DID) analysis assessed changes in surgical treatment between patients living in ME and non-ME states.

Results

Among 19,745 patients, 12,220 (61.9%) were diagnosed before ME and 7525 (38.1%) after. Although overall utilization of surgery decreased after expansion (ME, pre-expansion: 62.2% versus post-expansion: 51.6%; non-ME, pre-expansion: 62.1% versus post-expansion: 50.8%, p < 0.001), this trend varied relative to insurance status. Notably, receipt of surgery increased among uninsured/Medicaid patients living in ME states after expansion (pre-expansion: 48.1%, post-expansion: 52.3%, p < 0.001). Moreover, treatment at academic or high-volume facilities increased the likelihood of undergoing surgery before expansion. After expansion, treatment at an academic facility and living in an ME state (OR 1.28, 95% CI 1.07–1.54, p < 0.01) were predictors of surgical treatment. DID analysis demonstrated increased utilization of surgery for uninsured/Medicaid patients living in ME states relative to non-ME states (uninsured/Medicaid: 6.4%, p < 0.05), although no differences were noted among patients with other insurance statuses (overall: 0.7%, private: −2.0%, other: 0.3%, all p > 0.05).

Conclusions

Implementation of ME heterogeneously impacted utilization of care in early-stage HCC. Notably, uninsured/Medicaid patients residing in ME states demonstrated increased utilization of surgical treatment after expansion.

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Authors and Affiliations

  1. Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Henrique A. Lima MD, Yutaka Endo MD, PhD, Zorays Moazzam MD, Laura Alaimo MD, Mary Dillhoff MD, Alex Kim MD, Joal Beane MD, Aslam Ejaz MD, Jordan Cloyd MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

  2. Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

    Henrique A. Lima MD & Vivian Resende MD, PhD

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  1. Henrique A. Lima MD
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  2. Yutaka Endo MD, PhD
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Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Lima, H.A., Endo, Y., Moazzam, Z. et al. The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care. Ann Surg Oncol 30, 4589–4599 (2023). https://doi.org/10.1245/s10434-023-13562-9

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