Mass. Insurance Expansion Associated With Increased Probability of Minimally Invasive Surgery for Nonwhite Patients, Reduced Racial Disparities

Health care reform in Massachusetts in 2006 that expanded insurance coverage was associated with a greater probability that nonwhite patients had minimally invasive surgery (MIS) for appendicitis and cholecystitis (inflammation of the gallbladder), and it was associated with reduced racial disparities, according to a study by Andrew P. Loehrer, M.D., of Massachusetts General Hospital, Boston, and colleagues.

Laparoscopic surgery has become the standard of care to treat appendicitis and cholecystitis. However lack of insurance and nonwhite race/ethnicity have both been associated with lower use of laparoscopic surgery for both diagnoses, according to the study background.

Researchers sought to evaluate the impact of Massachusetts health care reforms on racial disparities in MIS. The study included all hospital discharges (n=167,560) of nonelderly white, black or Latino patients with or without government insurance who underwent treatment for acute appendicitis or cholecystitis at hospitals from 2001 through 2009. Massachusetts was compared with six control states (Maryland, New York, New Jersey, Arizona, Florida and Washington).

Before the 2006 reforms, nonwhite patients in Massachusetts had a 5.21-percentage point lower probability of MIS compared with white patients, according to the results. Nonwhite patients in control states had a 1.39-percentage point lower probability of MIS. After the 2006 reforms, nonwhite patients in Massachusetts had a 0.06-percentage point greater chance of MIS compared to white patients, while nonwhite patients in the control states had a 3.19-percentage point lower probability of MIS.

“Therefore, the measured racial disparity in MIS disappeared in Massachusetts after health care reform while persisting in control states,” the authors note.

The authors suggest more studies need to be conducted to dissect the forces behind racial disparities: “However, our findings provide optimistic evidence for decreased variation in MIS by patient race/ethnicity after expansion of health insurance coverage in Massachusetts,” they conclude.

(JAMA Surgery. Published online October 2, 2013. doi:10.1001/jamasurg.2013.2750.