Elsevier

JACC: Heart Failure

Volume 7, Issue 1, January 2019, Pages 56-62
JACC: Heart Failure

Clinical Research
Emerging Trends in Financing of Adult Heart Transplantation in the United States

https://doi.org/10.1016/j.jchf.2018.10.001Get rights and content
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Abstract

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.

Key Words

health insurance
health policy
heart transplantation
payment

Abbreviations and Acronyms

CMS
Centers for Medicare and Medicaid Services
UNOS
United Network for Organ Sharing

Cited by (0)

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.

Drs. DeFilippis and Vaduganathan contributed equally to this work and are joint first authors.