• Cathy J Bradley, Bassam Dahman, Lisa M Shickle, and Woolton Lee.
• Department of Healthcare Policy and Research, Massey Cancer Center, Virginia Commonwealth University, PO Box 980430, Richmond, VA 23298-0430, USA. cjbradley@vcu.edu
• Health Serv Res. 2012 Apr 1; 47 (2): 677-97.

ObjectiveTo determine whether safety net and non-safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and African American women.Data SourcesSix years of Virginia Cancer Registry and Virginia Health Information discharge data were linked and supplemented with American Hospital Association data.Study DesignHierarchical generalized linear models and linear probability regression models were used to estimate the relationship between hospital safety net status, the explanatory variables, and the days from diagnosis to mastectomy and the likelihood of breast reconstruction.Principal FindingsThe time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source. Medicaid insured and uninsured women were approximately 20 percent less likely to receive reconstruction than privately insured women. African American women were less likely to receive reconstruction than white women.ConclusionsFollowing the implementation of health reform, disparities may potentially worsen if safety net hospitals' burden of care increases without commensurate increases in reimbursement and staffing levels. This study also suggests that Medicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system.© Health Research and Educational Trust.

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