Thyroid Cancer Surgeries Linked With Insurance Expansion
Surgical management of thyroid cancer varies across the United States. In Massachusetts, there has been an increase in the surgical management of this disease, which has been attributed to legislation that expanded insurance coverage in 2006.
Compared with control states (New Jersey, New York, and Florida), there was a 26% increase in the rate of patients who underwent thyroidectomy and a 22% increase in the rate of patients who underwent neck dissection in Massachusetts. The increased rates were disproportionately higher for nonwhites compared with whites.
“This is the first study to show that increase in access to care is associated with an increase in the treatment of thyroid cancer,” endocrine surgeon and corresponding author Benjamin C. James, MD, assistant professor of surgery at Indiana University Medical Center, Indianapolis, told Medscape Medical News.
The study was published online April 5 in JAMA Surgery.
“The data are compelling and alarming,” thyroid cancer surgeon Louise Davies, MD, associate professor of surgery/otolaryngology at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, told Medscape Medical News. Dr Davies was not associated with this study.
“It is shocking to see how much surgical rates have changed after insurance expansion in Massachusetts,” she added. “On the one hand, one hopes that patients are getting the care they need, but I worry that this is more than just that,” she noted.
“As life expectancy and the incidence of thyroid cancer rises in the United States, the management and treatment of survivors of thyroid cancer may have a significant economic burden on the US healthcare system,” the authors warn. An estimated $1.6 billion has been cumulatively spent on the treatment of thyroid cancer since 1985. Of that sum, 41% was spent on the diagnosis, surgery, and adjuvant therapy for new cases, and 27% was spent for surveillance of survivors, they add.
The authors used the Hospital Cost and Utilization Project State Inpatient Databases for Massachusetts, New Jersey, New York, and Florida to identify inpatient admissions for thyroid cancer between January 2001 and December 2011. ICD-9 codes were used to determine data for thyroidectomy and neck dissection for thyroid cancer.
Of 56,581 inpatient admissions, 8534 admissions were in Massachusetts, and 48,047 were in the control states. Patients in Massachusetts were more likely to be white and were less likely to be admitted to private hospitals.
The authors report that before the 2006 reform, there was no difference in trend between Massachusetts and the control states for rates of thyroidectomy or neck dissection. Similarly, there was no difference in the trend for Medicaid/Commonwealth Care recipients (GSSP) or those with private insurance.