The Economics of Surgery

Kidney cancer treatments different for medicare or medicaid patients

(RxWiki News) The American health care system prides itself on being the best in the world for advanced, evidenced based medicine and innovative surgical procedures.

Yet it seems that isn't the whole picture, and technological advances are not always applied universally.

The traditional treatment for kidney cancer is removing the entire kidney, which can really limit the body's ability to filter blood. An alternative with better outcomes has been introduced over the last decade, partial nephrectomy, where as much healthy kidney is preserved as possible.

"Ask your surgeon about all options available to you."

Research by a group from the Henry Ford Center was presented at the American Urological Association's annual meeting, and the data suggests that economics did play a role in the surgical treatment of kidney cancer patients without additional insurance.

Without more information about the nature of the cancers in the patients, it is impossible to draw definite conclusions, but the correlation raises several important questions about access to health care, which the study author, Quoc-Dien Trinh, MD, commented on.

"We couldn't adjust for such things as disease characteristics like tumor size, grade or location," Dr. Trinh stated. "Also, it's possible that these patients have inferior access to care, so present with worse disease, when partial nephrectomy isn't feasible.

"However, it is also entirely possible that patients within this bracket are treated at hospitals that don't have the proficiency to perform this advanced surgical technique, therefore putting these patients at risk of the well-documented, long-term effects of radical nephrectomy."

The study looked at 375,986 kidney cancer patients from throughout the U.S. from 1998 to 2009. Most surgeries were total kidney removal, but 63,670 were partial removals.

Conclusions from the study were that patients were more likely to receive a partial removal if they were:

  • younger than the average
  • came from a zip code with a high average income
  • had surgery at a teaching hospitals
  • had surgery in a hospital with higher than average volume
  • located in the Northeastern United States.
  • had additional insurance

Dr. Trinh concluded the presentation by saying that there are plausible reasons for the difference, but if the disparity is due to economics, "then mechanisms need to be implemented to ensure that these patients receive higher quality care, and that they receive the appropriate treatment, namely partial nephrectomy, whenever possible," Dr. Trinh says.

The potential problems highlighted by this study are, to some extent, a reflection of the big issues in American health care, and as Dr. Trinh states, "We have to change the way insurance is distributed and how health care is delivered. But this is easier said than done."

Research findings presented at conferences are considered preliminary until publication in a peer-reviewed journal.

The study was backed by the Henry Ford Center.

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Review Date: 
May 23, 2012