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首页> 外文期刊>Journal of women’s health >Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery
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Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery

机译：联邦医疗保险授权和医疗保健利用：《妇女健康和癌症权利法》和《乳房重建手术》的使用案例

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Background: Utilization of breast reconstruction services remains low among women who underwent mastectomy despite the improvement in quality of life associated with this treatment. The objective of this study is to identify the effect of the Women's Health and Cancer Rights Act (WHCRA)an understudied ongoing federal law that mandated insurance coverage of breast reconstruction following mastectomy beginning in 1999on use of reconstructive surgery after mastectomy. Methods: We use a difference-in-differences (DD) approach to identify the change in breast reconstruction utilization induced by WHCRA by comparing the pre- and post-policy changes in utilization between states that did not have existing laws mandating coverage before the WHCRA (treatment group) and those that had such state laws (control group). The data are from the Surveillance, Epidemiology, and End Results program. The main sample includes 15,737 female patients who were under the age of 64 and underwent mastectomy within 4 months of diagnosis of early stage breast cancer during 1998 and 2000. Results: Based on the DD model, the odds of using reconstruction services in the states without preexisting laws increased after the WHCRA by 31% in 1999 and 36% in 2000 (compared with 1998 before the WHCRA). These effects are masked in a simple pre/post model for change in reconstruction across all states. Additional analyses through 2007 indicate that the WHCRA had long-term effects on utilization. Furthermore, analyses by state indicate that most states in the treatment group experienced a significance increase in utilization. Conclusions: The use of breast reconstruction after mastectomy significantly increased after the WHCRA. At a minimum, our estimates may be considered the lower bound of the real policy effect.
机译：背景：尽管进行了乳房切除术的妇女生活质量得到改善，但乳房重建服务的使用率仍然很低。这项研究的目的是确定《妇女健康和癌症权利法》（WHCRA）的影响，该法律是一项经过深入研究的现行联邦法律，该法规定自1999年开始的乳房切除术后乳房重建手术后使用乳房重建手术，必须对乳房重建进行保险。方法：我们通过差异比较（DD）方法，通过比较WHCRA之前没有现行法律规定覆盖范围的州之间的政策使用前后政策变化，来识别WHCRA引起的乳房重建利用率变化。 （治疗组）和具有此类州法律的人（对照组）。数据来自监视，流行病学和最终结果程序。主要样本包括15737名女性患者，这些女性患者在1998年和2000年诊断为早期乳腺癌的4个月内，年龄在64岁以下，并接受了乳房切除术。结果：基于DD模型，在没有患病的州中使用重建服务的可能性WHCRA之后的现有法律增加了1999年的31％和2000年的36％（与之相比，WHCRA之前的1998年）。在简单的前/后模型中掩盖了这些影响，以便在所有状态下进行重构更改。到2007年的其他分析表明，WHCRA对利用率产生了长期影响。此外，按州进行的分析表明，治疗组中的大多数州的利用率均显着提高。结论：WHCRA后乳房切除术后乳房重建的使用显着增加。至少，我们的估计值可以视为实际政策效果的下限。

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