# Insurance Coverage and Workforce Incentives to Improve Access to Surgical Care

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $361,527

## Abstract

PROJECT SUMMARY ABSTRACT
 Improving access to surgical care remains a persistent challenge in the United States. While some
areas of the country are crowded with high-intensity resources, more than a third of US counties do not have a
single surgeon. Even in areas where there are enough providers, more than 29 million American lack
insurance coverage preventing access to elective surgical care. As a result of a limited surgical workforce,
inadequate insurance coverage or both, patients with limited access delay care until the condition requires
emergent intervention. These emergency operations, that are more costly than their elective counterparts due
to more complication and readmissions, are estimated to account for more than $1 billion in preventable
spending. In response, the Centers for Medicare and Medicaid Services (CMS) implemented multiple access
strategies including broader insurance coverage (e.g. Medicaid Expansion) and workforce incentives (e.g.
Health Profession Shortage Areas (HPSA)). By improving access, the policies are meant to facilitate elective
surgical care, prevent adverse events and reduce episode spending. Because the CMS policies outlined here
focus on improving access, we will evaluate a broad range access sensitive surgical conditions. These
conditions are preferentially treated with elective, or scheduled, operations when access is optimal. However,
when access is limited, their natural progression leads to unresolving symptoms that ultimately require an
emergency surgical procedure. Examples include abdominal aortic aneurysms which can rupture, ventral
hernias which can strangulate, and colorectal cancers that can cause life-threatening obstructions. As such,
these operations being performed electively versus emergently can serve as an indicator of access. Each CMS
policy was implemented with both geographic and temporal variation resulting in beneficiaries exposed to one
policy, both policies or neither. We will exploit these overlapping natural experiments to understand and isolate
the effects of each policy alone as well as their combined effects using administrative claims from Medicare
Claims and Healthcare Costs Utilization Project. We will leverage our extensive experience with natural
experiment study design to appropriately isolate the effects of each policy on surgical access, quality and
costs. This study will bring important evidence to evidence-based policy making as many states are still
adopting Medicaid Expansion and congress debates the merits of continued HPSA subsidies.

## Key facts

- **NIH application ID:** 10865034
- **Project number:** 5R01DK137466-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Andrew Mounir Ibrahim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $361,527
- **Award type:** 5
- **Project period:** 2023-07-01 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10865034

## Citation

> US National Institutes of Health, RePORTER application 10865034, Insurance Coverage and Workforce Incentives to Improve Access to Surgical Care (5R01DK137466-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10865034. Licensed CC0.

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