Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act: A national database study

Vignesh Ramachandran, Katherine E. Park, Jesal R. Shah, Madeleine Duvic

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalDermatology online journal
Volume25
Issue number11
StatePublished - 2019

Keywords

  • ACA
  • Affordable Care Act
  • CTCL
  • Cutaneous T-cell lymphoma
  • Diagnosis
  • Medicaid
  • Population-based
  • SEER
  • Surveillance Epidemiology and End Results Cancer Database

ASJC Scopus subject areas

  • Dermatology

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