Full implementation of the Affordable Care Act could result in as many as 500,000 more discretionary surgical procedures by 2017, based on health reform experiences in Massachusetts.
Dr. Chandy Ellimoottill of the University of Michigan, Ann Arbor, and associates analyzed the potential effect of the ACA on surgical procedures by examining the Massachusetts insurance expansion and the utilization of discretionary and nondiscretionary surgical treatment. They reviewed inpatient databases from Massachusetts and two control states – New Jersey and New York – to identity nonelderly patients who underwent discretionary procedures and nondiscretionary procedures from January 2003 to December 2010. Their findings were published July 2 in JAMA Surgery.
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Due to the Affordable Care Act, discretionary surgical procedures like joint replacement surgery or back surgery could be on the rise.
The investigators defined discretionary surgery as procedures that were elective or preference-sensitive, such as joint replacement surgery or back surgery. Nondiscretionary surgeries were those that were life-saving or imperative, such as hip fracture repair.
Insurance expansion in Massachusetts was associated with a 9.3% increase in discretionary surgery and a 4.5% decrease in nondiscretionary surgery, Dr. Ellimoottil and colleagues found (JAMA Surg. 2014 July 2 [doi:10.1001/jamasurg.2014.857]).
Based on their findings, the ACA could yield an additional 465,934 discretionary surgical procedures by 2017. The researchers noted that their conclusions suggest insurance expansion results in greater utilization of discretionary inpatient procedures often performed to improve quality of life rather than to address immediate life-threatening conditions.
The study was supported primarily by federal grants (Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases). The authors reported no relevant conflicts of interest.