Health care expansion in Massachusetts, which became a model for the controversial Patient Protection and Affordable Care Act (Obamacare) caused a surge in surgeries for thyroid cancer.
What that means depends on who is doing the framing. One side can argue that surgeons now had the state government paying for everything, so more were done, while another can argue that people were more likely to go to the doctor.
Thyroid cancer diagnoses have gone up about 5 percent per year over the last decade. Some is over-diganosis, some may be that the effects of lifestyles in previous generations are catching up to people, but few argued it was due to health care expansion.
Yet a new paper (JAMA Surgery, April 5, 2017, doi:10.1001/jamasurg.2017.0461) argues just that. The authors found that Massachusetts insurance expansion was associated with a 26 percent increased rate of thyroidectomy and a 22 percent increased rate of neck dissections for thyroid cancer. The increased rate occurred disproportionately among nonwhite patients, with a 68 percent increased rate of undergoing a thyroidectomy and 45 percent increased rate of undergoing neck dissections among minorities compared with control states.
The researchers used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy (removal of all or part of the thyroid gland) between 2001 and 2011 in Massachusetts (n = 8,534) and three control states (n = 48,047).
"Our findings provide encouraging evidence that insurance coverage may help mitigate racial or socioeconomic disparities while also raising questions concerning the relative appropriateness of the observed management of thyroid cancer, which deserves additional investigation," the authors say.
