TY - JOUR
T1 - Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act
T2 - A national database study
AU - Ramachandran, Vignesh
AU - Park, Katherine E.
AU - Shah, Jesal R.
AU - Duvic, Madeleine
N1 - Publisher Copyright:
© 2019 Dermatology Online Journal. All rights reserved.
PY - 2019
Y1 - 2019
N2 - The Affordable Care Act (ACA) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes.
AB - The Affordable Care Act (ACA) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes.
KW - ACA
KW - Affordable Care Act
KW - CTCL
KW - Cutaneous T-cell lymphoma
KW - Diagnosis
KW - Medicaid
KW - Population-based
KW - SEER
KW - Surveillance Epidemiology and End Results Cancer Database
UR - http://www.scopus.com/inward/record.url?scp=85079220013&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85079220013&partnerID=8YFLogxK
M3 - Review article
C2 - 32045145
AN - SCOPUS:85079220013
SN - 1087-2108
VL - 25
JO - Dermatology online journal
JF - Dermatology online journal
IS - 11
ER -