Medicaid expansion can raise demand for gynecologic cancer care
Hospitalizations hiked in Virginia as care opened to more low-income residents
An expansion of Medicaid services in the state of Virginia led within months to more young and middle-aged women of lower income being treated in hospitals for gynecologic cancer, a study reports.
These findings are “consistent with the detection of more undiagnosed, complicated, and late-stage cancer in now accessible health services … for low-income populations who were uninsured before Medicaid expansion,” the researchers wrote.
The study, “The effect of Medicaid expansion on female gynecologic cancer-related inpatient admissions,” was published in the journal Women’s Health.
Medicaid coverage in Virginia rose by about 27% after 2019 change in eligibility
All female gynecologic cancers, like those of the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries, have higher mortality rates among people of lower socioeconomic status due to a lack of healthcare access. Easier access via affordable health insurance increases the likelihood of cancer screening, early diagnosis, and appropriate treatment, the researchers noted.
In January 2019, Virginia expanded Medicaid eligibility to include adults ages 19 to 64 with household incomes up to 138% of the federal poverty level to make affordable healthcare more accessible. As of 2021, enrollment in Medicaid — a joint U.S. federal and state government program, administered by each state, providing health insurance to low-income residents — has grown there by about 27%.
“Health care must be affordable and convenient to be considered accessible,” the researchers wrote, noting that more than 10% of “non-elderly” state residents lacked health insurance before the expansion.
A drop in the use of high-cost healthcare, such as inpatient hospital services, would be expected over time. However, immediately after the expansion, an increased demand for high-cost hospital services could be expected as more people, who previously lacked access to care, enter the healthcare system for cancer treatment or diagnosis, including those with late-stage cancers.
The scientists, at Virginia Commonwealth University, examined the effect of Medicaid expansion on high-cost inpatient admissions “that can be prevented by having regular screening tests and early treatment in outpatient settings.”
They compiled Virginia inpatient claims data by quarter from 2017 to the end of 2019 for all women, ages 18 to 64, with short-term admission to a hospital with a diagnosis of gynecologic cancer. For comparison, they included data from the North Carolina Healthcare Cost and Utilization Project, because this neighboring state expanded Medicaid in December 2023, more than four years after Virginia, and it had a similar demographic and female gynecologic cancer incidence and mortality rate between 2016 and 2020.
Steady rise in hospitalizations with ‘pent-up demand’ among uninsured
For both states, the average age of patients hospitalized for gynecologic cancer was 42, with an average hospital stay of about four days. There were 18,749 inpatient admissions for gynecologic cancer in Virginia and 25,168 in North Carolina between 2017 and 2019.
The average number of inpatient admissions per county per quarter for gynecologic cancer increased in the months after Medicaid expansion in Virginia but not in North Carolina, data showed.
Compared with the first quarter of 2019 (January to March), the average predicted number of inpatient admissions for gynecologic cancer in Virginia significantly rose by 11.2% in the third quarter (July to September) and by 9.2% in the fourth quarter (October to December).
Relative to North Carolina, although not significant, the predicted number of inpatient gynecologic cancer admissions in Virginia increased by 4.8% in the second quarter, 4.9% in the third quarter, and 5.5% in the fourth quarter, compared with the first quarter of 2019.
The effect of Medicaid expansion into 2020 was challenging due to the COVID-19 pandemic, the team noted.
“Female gynecologic cancer-related admissions steadily increased in [Virginia] compared to [North Carolina] following Medicaid expansion,” the scientists concluded. It’s possible that “initial pent-up demand among uninsured individuals with undiagnosed female gynecologic cancer could have contributed to the increase in inpatient admissions.
“Policymakers should note that eligibility expansion may lead to different effects on inpatient admissions compared to the expansion of benefits for covered members,” they added.
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