Will ACA Increase the Rate of Discretionary Surgery?

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Will ACA Increase the Rate of Discretionary Surgery?
Will ACA Increase the Rate of Discretionary Surgery?

(HealthDay News) — Based on the Massachusetts' health care reform experience, full implementation of the Affordable Care Act could lead to increased rates of discretionary surgeries, according to a study published July 2 in JAMA Surgery.

Chandy Ellimoottil, MD, from the University of Michigan in Ann Arbor, and colleagues examined the differential effect of insurance expansion on discretionary vs. nondiscretionary inpatient surgery. State inpatient databases from Massachusetts and two control states (New Jersey and New York) were used to identify nonelderly adult patients (aged 19–64 years) who underwent discretionary (e.g., joint replacement and back surgery) versus nondiscretionary surgical procedures (e.g., cancer surgery and hip fracture repair) from January 1, 2003–December 31, 2010.

The researchers identified 836,311 surgical procedures. In Massachusetts, insurance expansion correlated with a 9.3% increase in the use of discretionary surgery (P=0.02) and a 4.5% decrease in the rate of nondiscretionary surgery (P=0.009). For discretionary surgery, similar effects were observed in all subgroups, with the greatest increase among nonwhite participants (19.9%; P<0.001). Full implementation of national insurance expansion was estimated to yield 465,934 additional discretionary surgical procedures by 2017.

"If similar changes are seen nationally under the Affordable Care Act, the value of insurance expansion for surgical care may depend on the relative balance between increased expenditures and potential health benefits of greater access to elective inpatient procedures," the authors write.

One author disclosed financial ties to the medical technology industry.

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