Project Summary:
There is strong evidence that breast cancer patients treated in hospitals with high breast cancer volumes have improved survival. The effect is large, consistent across data sources, and robust to alternative analytical methods, including those accounting for patient self-selection. Evidence also suggests that the substantially lower five-year survival among low-income women with incident early-stage breast cancer can be attributed, in large part, to their treatment at low volume facilities. Leveraging positive findings from a recent evaluation of a centralization policy implemented in 2009 by the New York State Department of Health whereby it precluded payment for breast cancer surgery for New York Medicaid (low-income) beneficiaries treated in low-volume facilities, the project team will to apply quantitative and qualitative methods to examine the feasibility of a centralization policy in Wisconsin.
Although the New York policy resulted in a marked narrowing of the disparity between Medicaid beneficiaries and other breast cancer patients in that state, a better understanding of Wisconsin’s healthcare markets, resources, and needs is critical to inform the design of a centralization policy for this state. In addition, concerns about whether centralization might result in unintended consequences and reduced access among vulnerable rural (≈ 27%) and low-income (≈ 30%) Wisconsin women with incident breast cancer, for example, must be addressed before Wisconsin policymakers might consider implementing a similar policy.
The project team will directly address these issues in this project. Findings from this effort will be critical in informing and tailoring policy interventions aimed at optimizing breast cancer care delivery in Wisconsin while ensuring that they are both effective and equitable. The study will produce actionable, policy-relevant findings which can be used by Wisconsin patients, policymakers, and payers to improve the outcomes for persons with breast cancer, the most common cancer among Wisconsin's women.