The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

Nicolas W. Villelli, Hong Yan, Jian Zou, Nicholas Barbaro

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors' prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS: Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers' compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS: The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and "other" categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65-84 years old, with a decrease in surgeries for those 18-44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS: After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

Original languageEnglish (US)
Pages (from-to)694-699
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume27
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Health Care Reform
Spine
Insurance
Medicare
Patient Protection and Affordable Care Act
Medicaid
Age Groups
Government Programs
Delivery of Health Care
Workers' Compensation
International Classification of Diseases
Health Insurance
Inpatients
Demography

Keywords

  • Massachusetts health care reform law
  • Neurosurgical procedures
  • Patient protection and affordable care act
  • Payer-mix status
  • Physician compensation
  • Spine surgery
  • Uninsured patients

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age. / Villelli, Nicolas W.; Yan, Hong; Zou, Jian; Barbaro, Nicholas.

In: Journal of Neurosurgery: Spine, Vol. 27, No. 6, 01.12.2017, p. 694-699.

Research output: Contribution to journalArticle

Villelli, Nicolas W. ; Yan, Hong ; Zou, Jian ; Barbaro, Nicholas. / The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 27, No. 6. pp. 694-699.
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AB - OBJECTIVE: Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors' prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS: Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers' compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS: The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and "other" categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65-84 years old, with a decrease in surgeries for those 18-44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS: After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

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