Health care reform increases access to surgery for thyroid cancer


Health insurance expansion in Massachusetts was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer, according to research published in JAMA Surgery (published online April 5, 2017; doi:10.1001/jamasurg.2017.0461).


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Thyroid cancer incidence has been increasing by 5% each year over the past decade and is the fifth most common cancer in women in the US. While the rise in thyroid cancer incidence is likely due to numerous reasons, there has been limited research assessing how insurance expansion – resulting from the Affordable Care Act and health care reform – influences the diagnosis and treatment of thyroid cancer.

Andrew P Loehrer, MD, MPH, department of surgery, Massachusetts General Hospital, and colleagues sought to evaluate the association between insurance expansion and thyroid cancer treatment by using the 2006 Massachusetts health reform. Researchers identified patients between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48,047) who were admitted to the hospital for thyroidectomy for thyroid cancer. Patients were controlled for age, sex, comorbidities, and secular trends. Difference-in-difference models were used to evaluate the association between the health care reform and thyroid cancer treatment.

In comparison to control states, researchers found that the insurance expansion in Massachusetts was associated with a 26% increase in thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02). Additionally, the Massachusetts cohort had a 22% increased rate of neck dissection (incidence rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with the control states.

Findings of the study suggest that expanded insurance coverage has contributed largely to an increased rate of diagnoses and interventions on thyroid cancer, most likely because of an increased access to care. However, further studies are needed to evaluate the effect of health care expansion at a national level. – Zachary Bessette