Spillover Effects of State Mandated Benefit Laws: The Case of Outpatient Breast Cancer Surgery

By Bian, John; Lipscomb, Joseph et al. | Inquiry, Winter 2009 | Go to article overview

Spillover Effects of State Mandated Benefit Laws: The Case of Outpatient Breast Cancer Surgery


Bian, John, Lipscomb, Joseph, Mello, Michelle M., Inquiry


This paper examines the "spillover effects" of state laws that mandate inpatient coverage for breast cancer surgery. It looks at outpatient utilization of two types of breast cancer surgery among Medicare fee-for-service patients', who are exempt from state regulation. Using data from the Surveillanee, Epidemiology and End Results cancer registries and Medicare claims, we performed difference-in-differences analyses of patients in nine states from 1993 to 2002. The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points. Such a spillover effect may diminish the expected impact of federal coverage laws for inpatient breast cancer surgery, which have been proposed to achieve similar ends.

**********

Mandated benefit laws require health insurers to cover specified services such as a 48-hour hospital stay after delivery of a baby or reconstructive breast surgery after mastectomy (Laugesen et al. 2006). When adopted at the state level, these laws formally apply only to health insurance plans that are subject to state insurance regulation. They do not cover federal insurance programs, such as Medicare and Medicaid, Medigap plans, or employer-sponsored plans that fall within the purview of the federal Employee Retirement Income Security Act (ERISA).

Although states have been quite active in passing mandated benefit laws, many commentators have argued that federal mandates are needed to ensure that patients in ERISA plans, and patients in states without mandated benefit laws, enjoy the same protection as patients in plans covered by the laws (Laugesen et al. 2006). However, evidence suggests that patients whose plans are not formally covered by mandated benefit laws may nonetheless receive the laws' intended protection via so-called "spillover effects." For example, state "drive-through delivery" laws requiring coverage for a minimum hospital stay after childbirth indirectly influenced care received by patients enrolled in ERISA plans (Liu, Dow, and Norton 2004: Dow, Harris, and Liu 2006). As a result, the 1996 federal drive-through delivery law may have generated little additional benefit. Thus, the extent to which state mandated benefit laws entail spillover effects on nonregulated populations has implications for any debate on federal legislation.

In the last decade, there has been a significant legislative focus on mandates aimed at curbing use of the controversial practice of "drive-through," or outpatient, breast cancer surgery (Case, Johantgen, and Steiner 2001: Warren et al. 1998: Sinks and Zarfos 1998). The growing prevalence of outpatient breast cancer surgery, particularly outpatient mastectomy, attracted widespread public attention in 1997, when its potential dangers were mentioned in President Clinton's State of the Union Address (Clinton 1997). Although proposed federal legislation requiring insurers to cover a minimum hospital stay for mastectomy and breast-conserving surgery with lymph node dissection (BCS/LND) has yet to succeed, many states have adopted similar provisions since 1997 (National Cancer Institute 2007). The 110th Congress again considered the merits of adopting a nationwide mandate, the Breast Cancer Patient Protection Act of 2007 (H.R. 758 and S. 459).

The available evidence regarding the effects of state mandated benefit laws is limited. The two existing multistate, longitudinal studies of state drive-through delivery laws are ex post analyses, examining the effect of the laws alter the federal law had already gone into effect (Liu, Dow, and Norton 2004: Dow, Harris, and Liu 2006). In this paper, we conducted an ex ante analysis of state mandated benefit laws for breast cancer surgery to inform the ongoing debate about the federal Breast Cancer Patient Protection Act. Using a natural experimental design, we examined the spillover effects of state laws mandating inpatient coverage for mastectomy and BCS/LND on the utilization of outpatient breast cancer surgery by patients enrolled in Medicare fee-for-service (FFS) plans, which are exempted from state regulation. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Spillover Effects of State Mandated Benefit Laws: The Case of Outpatient Breast Cancer Surgery
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.