OBJECTIVE To quantify recent trends in access to timely, high-quality, affordable surgical care in the US. BACKGROUND Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens. METHODS This observational cross-sectional study evaluates multiple domains of access to surgical care across the US from 2011-2015 and 2016-2020. Our stepwise model included timeliness (<60-minute drive time), quality (surgically capable hospital with ≥3 CMS stars), and affordability (neither uninsured nor underinsured) of access to surgical care using a novel combination of data from the American Hospital Association, Medicare claims, CMS's Five-Star Quality Rating System, the American Community Survey, and the Medical Expenditure Panel Survey. RESULTS The number of Americans lacking access to timely, high-quality, affordable surgical care increased from 97.7 million in 2010-2015 to 98.7 million in 2016-2020. Comparing these two periods, we found improvements in the number of Americans lacking access due to being uninsured (decrease from 38.5 to 26.5 million). However, these improvements were offset by increasing numbers of Americans for whom timeliness (increase from 9.5 to 14.1 million), quality (increase from 3.4 to 4.9 million), and underinsured status (increase from 46.3 to 53.1 million) increased as barriers to access. Multiple sensitivity analyses using alternative thresholds for each access domain demonstrated similar trends. Those with insufficient access to care tended to be more rural (6.7% vs. 2.0%, P<0.001), lower income (40.7% vs. 30.0%, P<0.001), and of Hispanic ethnicity (35.9% vs. 15.8%, P<0.001). CONCLUSIONS Nearly one-in-three Americans lack access to surgical care that is timely, high-quality, and affordable. This study identifies the multiple actionable drivers of access to surgical care that notably can each be addressed with specific policy interventions.

中文翻译：

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美国及时获得高质量和负担得起的外科护理的趋势。


目的 量化美国获得及时、高质量、负担得起的外科护理的最新趋势。背景 在美国，获得外科护理的机会不足仍然是一个持续存在的问题。以前试图理解和量化美国获得外科护理的障碍缺乏全面的、与政策相关的视角。方法 这项观察性横断面研究评估了 2011-2015 年和 2016-2020 年美国获得外科护理的多个领域。我们的逐步模型包括获得外科护理的及时性（<60 分钟车程）、质量（手术能力强的医院，≥3 CMS 星）和获得外科护理的可负担性（既没有保险也没有保险不足），使用来自美国医院协会、医疗保险索赔、CMS 的五星级质量评级系统、美国社区调查和医疗支出小组调查的新数据组合。结果无法获得及时、高质量、负担得起的外科护理的美国人人数从 2010-2015 年的 9770 万增加到 2016-2020 年的 9870 万。比较这两个时期，我们发现由于没有保险而无法获得保险的美国人数量有所改善（从 38.5 人减少到 2650 万）。然而，这些改善被越来越多的美国人所抵消，这些美国人的及时性（从 9.5 增加到 1410 万）、质量（从 3.4 增加到 490 万）和保险不足状态（从 46.3 增加到 5310 万）增加了，因为获得障碍。对每个访问域使用替代阈值的多个敏感性分析显示出类似的趋势。那些无法获得护理的人往往更偏向农村（6.7% vs. 2.0%，P<0.001），收入较低（40.7% vs. 30.0%，P<0.001）和西班牙裔（35.9% vs. 15.8%，P<0.001）。 结论 近三分之一的美国人无法获得及时、高质量和负担得起的外科护理。本研究确定了获得外科护理的多种可操作驱动因素，值得注意的是，每个驱动因素都可以通过特定的政策干预措施来解决。