Trends in Timely Access to High-Quality and Affordable Surgical Care in the United States.

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-06 DOI:10.1097/SLA.0000000000006586
Cody Lendon Mullens, Andrew M Ibrahim, Nina M Clark, Nicholas Kunnath, Joseph L Dieleman, Justin B Dimick, John W Scott
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Abstract

Objective: To quantify recent trends in access to timely, high-quality, affordable surgical care in the US.

Background: Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens.

Methods: This observational cross-sectional study evaluates multiple domains of access to surgical care across the US from 2011-2015 and 2016-2020. Our stepwise model included timeliness (<60-minute drive time), quality (surgically capable hospital with ≥3 CMS stars), and affordability (neither uninsured nor underinsured) of access to surgical care using a novel combination of data from the American Hospital Association, Medicare claims, CMS's Five-Star Quality Rating System, the American Community Survey, and the Medical Expenditure Panel Survey.

Results: The number of Americans lacking access to timely, high-quality, affordable surgical care increased from 97.7 million in 2010-2015 to 98.7 million in 2016-2020. Comparing these two periods, we found improvements in the number of Americans lacking access due to being uninsured (decrease from 38.5 to 26.5 million). However, these improvements were offset by increasing numbers of Americans for whom timeliness (increase from 9.5 to 14.1 million), quality (increase from 3.4 to 4.9 million), and underinsured status (increase from 46.3 to 53.1 million) increased as barriers to access. Multiple sensitivity analyses using alternative thresholds for each access domain demonstrated similar trends. Those with insufficient access to care tended to be more rural (6.7% vs. 2.0%, P<0.001), lower income (40.7% vs. 30.0%, P<0.001), and of Hispanic ethnicity (35.9% vs. 15.8%, P<0.001).

Conclusions: Nearly one-in-three Americans lack access to surgical care that is timely, high-quality, and affordable. This study identifies the multiple actionable drivers of access to surgical care that notably can each be addressed with specific policy interventions.

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美国及时获得高质量和负担得起的外科护理的趋势。
摘要量化美国及时获得高质量、可负担得起的外科医疗服务的最新趋势:背景:在美国,无法充分获得外科医疗服务仍是一个持续存在的问题。以前曾试图了解和量化美国在获得外科医疗服务方面存在的障碍,但缺乏一个全面的、与政策相关的视角:本观察性横断面研究评估了 2011-2015 年和 2016-2020 年美国外科医疗服务获取的多个领域。我们的逐步分析模型包括及时性(结果:美国缺乏及时获得外科医疗服务的人口数量为 1.5 亿人,而缺乏及时获得外科医疗服务的人口数量为 2.5 亿人:无法获得及时、优质、负担得起的外科医疗服务的美国人数从 2010-2015 年的 9770 万增加到 2016-2020 年的 9870 万。比较这两个时期,我们发现因没有保险而无法获得医疗服务的美国人数有所改善(从 3850 万减少到 2650 万)。然而,这些改善被越来越多的美国人所抵消,这些人的及时性(从 950 万增加到 1410 万)、质量(从 340 万增加到 490 万)和保险不足的状况(从 4630 万增加到 5310 万)增加了他们获得医疗服务的障碍。使用每个就医领域的替代阈值进行的多重敏感性分析表明了类似的趋势。无法充分获得医疗服务的人往往更多地在农村地区(6.7% 对 2.0%,PConclusions.Net):将近三分之一的美国人无法获得及时、优质和负担得起的外科医疗服务。本研究确定了获得外科医疗服务的多种可操作驱动因素,这些因素都可以通过具体的政策干预措施加以解决。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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