Journal article
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
Journal of women's health (Larchmont, N.Y. 2002), Vol.24(8), pp.655-662
08/01/2015
DOI: 10.1089/jwh.2014.5057
PMID: 26131570
Abstract
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 1999—on 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.
Details
- Title: Subtitle
- 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
- Creators
- Yang Xie - 1Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IowaYuexin Tang - 1Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IowaGeorge L Wehby - 3National Bureau of Economic Research, Cambridge, MA
- Resource Type
- Journal article
- Publication Details
- Journal of women's health (Larchmont, N.Y. 2002), Vol.24(8), pp.655-662
- Publisher
- Mary Ann Liebert, Inc
- DOI
- 10.1089/jwh.2014.5057
- PMID
- 26131570
- ISSN
- 1540-9996
- eISSN
- 1931-843X
- Language
- English
- Date published
- 08/01/2015
- Academic Unit
- Preventive and Community Dentistry; Health Management and Policy; Economics; Public Policy Center (Archive)
- Record Identifier
- 9984063124502771
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