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Resolution of Racial Disparities in Minimally Invasive Surgery After Massachusetts Healthcare Reform
*Andrew P. Loehrer1,2, *Zirui Song3,2, *Hugh G. Auchincloss1, Matthew M. Hutter1
1Massachusetts General Hospital, Boston, MA;2National Bureau of Economic Research, Cambridge, MA;3Harvard Medical School, Boston, MA

To evaluate the impact of the 2006 Massachusetts health insurance expansion on racial disparities in utilization of minimally invasive surgery for low-income patients with acute appendicitis and acute cholecystitis.
Cohort study using Hospital Cost and Utilization Project State Inpatient Databases (SID) in Massachusetts and six control states from 2001 to 2009.
Inpatient Hospitals
All discharges (206,925) of white, black, or Latino patients with no insurance coverage, Medicaid, or CommonwealthCare insurance (collectively referred to here as low-income patients) who underwent an inpatient procedure for acute appendicitis or acute cholecystitis.
The 2006 health insurance expansion for low-income individuals in Massachusetts.
Main Outcome Measures:
1) Regression adjusted odds ratio of receiving laparoscopic versus open surgical procedure
2) Difference-in-difference estimates of proportion of patients undergoing laparoscopic procedures before and after Massachusetts insurance expansion.
Prior to the 2006 reform, minority patients had lower adjusted odds of receiving a minimally invasive procedure relative to white patients in both Massachusetts (OR 0.80, 95% CI [0.71-0.90], p <0.001) and in control states (OR 0.94, 95% CI [0.90-0.98], p=0.007). Adjusted difference-in-difference estimates showed 4.72% (P=0.002) greater increase in laparoscopic procedures for minority patients in Massachusetts after insurance expansion relative to concurrent trends in controls states. Racial disparities in minimally invasive approaches persisted in control states (OR 0.84, 95% CI [0.80-0.89], p<0.001) but were no longer present for minority patients in Massachusetts after insurance expansion (OR 1.00, 95% CI [0.86-1.16], p=0.981). 
After adjusting for potential confounders, insurance expansion for low-income patients in Massachusetts was associated with resolution of racial disparities in utilization of minimally invasive surgical procedures while disparities by race persisted elsewhere in the country.

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Abstract Submission Deadline:
May 5, 2014

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August 13, 2014

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August 11, 2014
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