Table 4.
Impact of Health Reform on Use of High Referral Rate Procedures by Area Income, Race/ethnicity & Procedure Category
| Procedure Category |
Cohort (area income) |
HRR Procedure Rates Non-elderly (40–64 years) |
HRR Procedure Rates Elderly (>=70 years) |
Net change (%): Post-reform change in procedure rate among non-elderly due to health reform | Cohort (race/ethnicity) |
HRR Procedure Rates Non-elderly (40–64 years) | HRR Procedure Rates Elderly (>=70 years) | Net change (%): Post-reform change in procedure rate among non-elderly due to health reform | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Post-Reform Change (%) in Procedure Rate | p-value (Difference in Lower vs. Highest Area Income Cohorts % Change=0) | Overall Post-Reform Change (%) in Procedure Rate | p-value (Difference in Lower vs. Highest Area Income Cohorts % Change=0) | Net Change (%) |
95% confidence interval |
Overall Post-Reform Change (%) in Procedure Rate | p-value (Difference in Non-White vs. White % Change=0) | Overall Post-Reform Change (%) in Procedure Rate | p-value (Difference in Non-White vs. White % Change=0) | Net Change (%) |
95% confidence interval |
|||
| Musculoskeletal | ||||||||||||||
| Low | 20% | <0.001 | 5% | <0.001 | 12% | [3%, 22%] | Hispanics | 31% | 0.017 | 19% | 0.354 | 8% | [−14%, 31%] | |
| Medium | 18% | 0.001 | 5% | 0.001 | 12% | [5%, 19%] | Blacks | 25% | 0.028 | 20% | 0.124 | 3% | [−12%, 19%] | |
| High | 9% | Reference | 9% | Reference | 1% | [−3%, 6%] | Whites | 15% | Reference | 8% | Reference | 6% | [2%, 11%] | |
| Urinary/Genital | ||||||||||||||
| Low | 12% | 0.595 | −11% | 0.397 | 21% | [10%, 31%] | Hispanics | 30% | <0.001 | −1% | 0.846 | 34% | [1%, 67%] | |
| Medium | 16% | 0.031 | −15% | 0.024 | 32% | [21%, 42%] | Blacks | 40% | <0.001 | 42% | <0.001 | 1% | [−22%, 24%] | |
| High | 9% | Reference | −7% | Reference | 15% | [2%, 28%] | Whites | 10% | Reference | −10% | Reference | 19% | [11%, 26%] | |
| Nervous | ||||||||||||||
| Low | −6% | 0.921 | −2% | 0.034 | −4% | [−16%, 9%] | Hispanics | 8% | 0.151 | −47% | <0.001 | 71% | [2%, 140%] | |
| Medium | −3% | 0.32 | 3% | 0.208 | −6% | [−20%, 8%] | Blacks | −16% | 0.122 | 43% | 0.03 | −51% | [−127%, 25%] | |
| High | −7% | Reference | 10% | Reference | −15% | [−28%, −3%] | Whites | −3% | Reference | 7% | Reference | −10% | [−19%, −2%] | |
| Cardiovascular | ||||||||||||||
| Low | −19% | 0.312 | −10% | 0.157 | −12% | [−19%, −4%] | Hispanics | −2% | 0.265 | 15% | 0.216 | −14% | [−52%, 24%] | |
| Medium | −15% | 0.849 | −13% | 0.021 | 5% | [−6%, 16%] | Blacks | 2% | 0.106 | 4% | 0.5 | 0% | [−65%, 66%] | |
| High | −15% | Reference | −4% | Reference | −16% | [−21%, 11%] | Whites | −17% | Reference | −7% | Reference | −11% | [−15%, −7%] | |
| Digestive | ||||||||||||||
| Low | −5% | 0.989 | −24% | 0.005 | 23% | [9%, 37%] | Hispanics | 8% | 0.245 | 4% | 0.508 | 10% | [−27%, 48%] | |
| Medium | −4% | 0.865 | −−9% | 0.505 | 0% | [−10%, 11%] | Blacks | 5% | 0.375 | −30% | 0.153 | 37% | [5%, 69%] | |
| High | −5% | Reference | −12% | Reference | 10% | [2%, 19%] | Whites | −4% | Reference | −13% | Reference | 10% | [5%, 15%] | |
Notes:
- Overall change (%) in procedure rate is the simple % change in the pre- and post-reform procedure rates. Difference in overall change by race/ethnicity and area income are obtained by comparing overall change. The figures for the All cohort are identical to those in Table 3.
- Net change (%) in procedure rate among non-elderly due to health reform are calculated from a separate (county fixed effects) Poisson regression with a difference-in-difference specification using combined non-elderly and elderly cohort data. Confidence intervals are based on bootstrapped standard errors (N=1,000 iterations) to adjust for clustering of observations within county.
- Area Income cohorts are defined as: low=lowest quartile zip codes, medium=second quartile and high=top two quartiles