Author + information
- Received September 3, 2018
- Revision received October 1, 2018
- Accepted October 2, 2018
- Published online December 31, 2018.
- Ersilia M. DeFilippis, MDa,∗,
- Muthiah Vaduganathan, MD, MPHa,∗,
- Sara Machado, PhD, MScb,
- Josef Stehlik, MDc and
- Mandeep R. Mehra, MDa,∗ (, )@MRMehraMD
- aBrigham and Women’s Hospital Heart and Vascular Center, and Harvard Medical School, Boston, Massachusetts
- bDepartment of Health Policy, London School of Economics and Political Science, London, United Kingdom
- cDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Mandeep R. Mehra, Brigham and Women’s Hospital Heart and Vascular Center, Center for Advanced Heart Disease, 75 Francis Street, Boston, Massachusetts 02115.
Objectives This study examined longitudinal trends in types of payers for adult heart transplantations in the United States.
Background In the last decade, volume of heart transplantations in the United States has substantially increased, a trend that has coincided with Medicaid expansion and greater insurance coverage in the general U.S. population. Limited data are available characterizing the changes in payer mix supporting these recent increases in heart transplantation activity.
Methods De-identified data were obtained from the Organ Procurement and Transplantation Network for heart transplantation recipients 18 to 64 years of age in the United States between 1997 and 2017. Primary sources of insurance payment were determined at the time of transplantation in aggregate and stratified by sex and race. Changes in volume and payer mix of patients added to the candidate waitlist between 1997 and 2017 were also examined.
Results A total of 36,340 adults from 18 to 64 years of age underwent heart transplantations between 1997 and 2017. Support by public payer insurance increased from 28.2% (in 1997) to a peak of 48.8% (in 2016). Medicaid coverage increased from 9.4% in 1997 to 15.5% in 2007 and remained stable to 2017 (14.7%; β-coefficient: +0.23% [0.04]; p < 0.001 for trend). Medicare beneficiaries accounted for 18.2% of recipients in 1997, 22% in 2007, and 30.3% in 2016 (β-coefficient: +0.60% [0.06]; p < 0.001 for trend). The proportion of transplantation candidates receiving Medicare coverage increased over time across all races and both sexes. Similar aggregate patterns were observed in waitlist trends for adult heart transplantation candidates.
Conclusions Public payer insurance has emerged as an increasingly dominant source of funding for adult heart transplantations in the United States, supporting nearly half of all transplants in 2017.
↵∗ Drs. DeFilippis and Vaduganathan contributed equally to this work and are joint first authors.
The contents are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Supported by Health Resources and Services Administration contract 234-2005-37011C. Dr. Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst, Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, U.S. National Institutes of Health award KL2 TR002542); and serves on advisory boards for Bayer AG and Baxter Healthcare. Dr. Stehlik consults for Medtronic. Dr. Mehra consults for Abbott, Medtronic, Janssen, Mesoblast, NupulseCV, Bayer, and Portola. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 3, 2018.
- Revision received October 1, 2018.
- Accepted October 2, 2018.
- 2019 American College of Cardiology Foundation
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