Wait Times and Delay
Surgery Wait Times and Specialty Services for Insured and Uninsured Breast Cancer Patients: Does Hospital Safety Net Status Matter?
Article first published online: 23 SEP 2011
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 2, pages 677–697, April 2012
How to Cite
Bradley, C. J., Dahman, B., Shickle, L. M. and Lee, W. (2012), Surgery Wait Times and Specialty Services for Insured and Uninsured Breast Cancer Patients: Does Hospital Safety Net Status Matter?. Health Services Research, 47: 677–697. doi: 10.1111/j.1475-6773.2011.01328.x
- Issue published online: 8 MAR 2012
- Article first published online: 23 SEP 2011
- American Cancer Society. Grant Number: RSGI-08-301-01
- Safety net hospitals;
- breast cancer;
To determine whether safety net and non-safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and African American women.
Six years of Virginia Cancer Registry and Virginia Health Information discharge data were linked and supplemented with American Hospital Association 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. African American 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 Medicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system.