Am J Surg. 2024 Jun:232:102-106. doi: 10.1016/j.amjsurg.2024.01.015. Epub 2024 Jan 18.

Brittany E Levy ¹, Anthony A Mangino ², Jennifer T Castle ³, Wesley A Stephens ⁴, Hannah G McDonald ⁵, Jitesh A Patel ⁶, Sandra J Beck ⁷, Avinash S Bhakta ⁸

Author information

¹University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA. Electronic address: brittany.levy@uky.edu.

²University of Kentucky Department of Biostatistics, 111 Washington Ave, Lexington, KY, 40536, USA. Electronic address: anthony.mangino@uky.edu.

³University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA. Electronic address: Jennifer.castle@uky.edu.

⁴University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA. Electronic address: Wesley.Stephens@uky.edu.

⁵University of Kentucky Department of Surgery, 780 Rose Street, Lexington, KY, 40536, USA. Electronic address: hmc236@uky.edu.

⁶University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA. Electronic address: Jitesh.Patel@uky.edu.

⁷University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA. Electronic address: Sandra.beck@uky.edu.

⁸University of Kentucky Division of Colorectal Surgery, 780 Rose Street, Lexington, KY 40536, USA. Electronic address: Avinash.Bhakta@uky.edu.

Abstract

Background: Kentucky was among the first to adopt Medicaid expansion, resulting in reducing uninsured rates from 14.3% to 6.4%. We hypothesize that Medicaid expansion resulted in increased elective healthcare utilization and reductions in emergency treatments by patients suffering Inflammatory Bowel Disease (IBD).

Methods: The Hospital Inpatient Discharge and Outpatient Services Database (HIDOSD) identified all encounters related to IBD from 2009 to 2020 in Kentucky. Several demographic variables were compared in pre- and post-Medicaid expansion adoption.

Results: Our study analyzed 3386 pre-expansion and 24,255 post-expansion encounters for IBD patients. Results showed that hospitalization rates dropped (47.7%-8.4%), outpatient visits increased (52.3%-91.6%) and Emergency visits decreased (36.7%-11.4%). Admission following a clinical referral similarly increased with a corresponding drop in emergency room admissions. Hospital costs and lengths of stay also dropped following Medicaid expansion.

Conclusion: In the IBD population, Medicaid expansion improved access to preventative care, reduced hospital costs by decreasing emergency care, and increased elective care pathways.