Study Finds Medicaid Melanoma Patients at Greater Risk for Surgical Delays

A recent study, published in JAMA Dermatology, investigated whether there was an association between insurance type and surgical delays for patients with melanoma.

This population-based, retrospective cohort study was comprised of 7629 patients that received a diagnosis of melanoma between 2004 and 2011 in North Carolina. The results showed that Medicaid patients were significantly more likely to experience delays in surgery when compared with privately insured patients.

Data were collected from the North Carolina Cancer Registry and then linked to administrative claims from Medicare, Medicaid, and private insurance. The inclusion criteria were patients with a diagnosis of melanoma from stages 0-3, and continuous insurance enrollment from at least 1 month prior to the diagnosis, and at least 12 months after the diagnosis.

The results showed that of the 7629 patients included, 4210 (55%) female; mean age, 64 years. The breakdown of each insurance type was 48% (n&thinsp;=&thinsp;3631) Medicare, 48% (n&thinsp;=&thinsp;3667) privately insured, and 4% (n&thinsp;=&thinsp;331) Medicaid patients. According to the study, privately insured patients were the least likely to experience a delay in definitive surgery, followed by Medicare and Medicaid patients (519 [14%], 609 [17%], and 79 [24%], respectively; P&thinsp; < &thinsp;.001). When researchers adjusted for demographic, the risk of surgical delay was significantly increased in patients with Medicaid when compared with private insurance (Risk Ratio [RR], 1.36; 95% CI, 1.09-1.70).

Findings showed that delays were more likely in nonwhite patients (RR, 1.38; 95% CI, 1.02-1.87). Surgical delays were less likely if the physician was performing the surgery (RR, 0.82; 95% CI, 0.72-0.93) or the diagnosing clinician was a dermatologist (RR, 0.81; 95% CI, 0.71-0.93) as compared with a non-dermatologist.

Timely administration of treatment for any disease is an important aspect of healthcare quality. Delays in treatment, defined by this study as surgery occurring more than 6 weeks after diagnosis, could be detrimental to the patient’s health. Researchers found that Medicaid patients experienced the most surgical delays. While treatment delays were common, they were less prevalent in patients diagnosed or surgically treated by a dermatologist. A reduction in delays in melanoma surgery could be achieved through better access to specialty care, as well as better cross-disciplinary coordination.

"Delays in melanoma care could be reduced through better access to specialty care and cross-disciplinary partnerships to ensure that patients can safely navigate the treatment episode," the authors concluded. "Understanding why Medicaid patients receive less timely care for melanoma should be given further scrutiny."