Cathy J. Bradley, Bassam Dahman, Lisa M. Shickle M.S., Woolton Lee
To determine whether safety net and non‐safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and frican merican women.
Six years of irginia ancer egistry and irginia ealth nformation discharge data were linked and supplemented with merican ospital ssociation data.
Hierarchical generalized linear models and linear probability regression models were used to estimate the relationship between hospital safety net status, the explanatory variables, and the days from diagnosis to mastectomy and the likelihood of breast reconstruction.
The time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source. Medicaid insured and uninsured women were approximately 20 percent less likely to receive reconstruction than privately insured women. frican merican women were less likely to receive reconstruction than white women.
Following the implementation of health reform, disparities may potentially worsen if safety net hospitals’ burden of care increases without commensurate increases in reimbursement and staffing levels. This study also suggests that edicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system.