Impact of Insurance Payer on Type of Breast Reconstruction Performed
Fouad Chouairi, B.S., Elbert J. Mets, B.A., Kyle S. Gabrick, M.D., Jacob Dinis, B.S., Tomer Avraham, M.D., Michael Alperovich, M.D., M.Sc..
Yale School of Medicine, New Haven, CT, USA.
PURPOSE: Disparities in breast reconstruction rates by socioeconomic status and hospital facilities have been described. The impact of insurance on breast reconstruction modalities when access to care is controlled is unknown.
METHODS: Records and outcomes for patients who underwent breast reconstruction at an academic medical center between 2013 and 2017 were reviewed. Patients reconstruction modalities were compared across insurance status.
RESULTS: 1683 breast reconstructions were analyzed with a mean age of 49.8 years and BMI of 27.9. The commercially insured were more likely to undergo microvascular autologous breast reconstruction (44.4% vs. 31.1%, p<0.001) with an odds ratio of 2.26 while patients with Medicare and Medicaid were significantly more likely to receive tissue expander/implant breast reconstruction with an odds ratio of 1.41 (41.7% vs. 47.7%, p=0.049). Comparing all patients with microvascular reconstruction, the commercially insured were more likely to receive a perforator flap (79.7% vs. 55.3% vs. 43.9%) with an odds ratio of 4.21 (p<0.001). When stratifying patients by median household income, the highest income quartile was most likely to receive a perforator flap (82.1%) (p<0.001) while the lowest income quartile was most likely to receive a muscle-sparing TRAM flap (36.4%) (p<0.001).
CONCLUSION: Patients at the same academic medical center receive significantly different breast reconstruction modalities when stratified by insurance and household income. Despite similar access to care, differences in insurance types may favor higher rates of perforator flap breast reconstruction among the commercially insured.
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