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With all the recent discussion and debate by the presidential candidates regarding healthcare issues, I thought a study published last month in CA: A Cancer Journal for Clinicians was quite timely. The study, titled Association of Insurance with Cancer Care Utilization and Outcomes, presents evidence that lack of adequate health insurance coverage is associated with reduced access to care and poorer outcomes for cancer patients . The article further presents data on the association between health insurance status and screening, stage at diagnosis and survival for breast and colorectal cancer.
American Cancer Society (ACS) researchers analyzed over half-a-million patient cases using data from the National Cancer Data Base as well as data from the 2005 and 2006 National Health Interview Survey conducted by the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC). Perhaps not surprisingly, the results show that uninsured individuals are (1) less likely to receive cancer screening, (2) more likely to be diagnosed at an advanced disease stage and (3) less likely to survive than privately insured individuals.
National health survey and healthcare
People who are uninsured or insured by government programs may face significant obstacles obtaining healthcare. Indeed, some physicians do not accept new patients without private insurance or uninsured individuals who are not able to pay the full cost at the time of visit. A recent national survey found that while 96% of office-based physicians were currently accepting new patients, 40.3% indicated they would not accept new charity cases, 25.5% did not accept new Medicaid cases and 13.9% did not accept new Medicare cases . This lack of access to healthcare can have adverse affects on preventive care and management for chronic conditions.
In the present ACS study, analyses of the 2006 National Health Interview Survey showed that 53.6% of uninsured people aged 18 to 64 years had no usual source of healthcare compared to just 9.9% of privately insured and 10.8% of individuals with Medicaid insurance. People who are uninsured were much more likely to report no healthcare visits in the past year than people who are privately- or Medicaid-insured. Compared to insured individuals, people who were uninsured were more likely to report that they did not get care due to cost, delayed care due to cost, did not get prescription drugs due to cost and had no healthcare visits in the past 12 months due to cost.
National health survey and cancer prevention
Up to two-thirds of cancers may be prevented through healthy lifestyle changes. Healthcare visits provide an opportunity for health providers to counsel people on smoking cessation and weight loss. However, uninsured individuals are much more likely to report no healthcare visits in the past 12 months than people who are Medicaid- or privately-insured and are thus much less likely to be advised to quit smoking or to lose weight. Further, analyses of the 2006 National Health Interview Survey showed that the likelihood of receiving recommended cancer screening tests varied by insurance status. Privately-insured women were most likely to have had a mammogram or Pap test, followed by Medicaid-insured women. Similarly, privately-insured men were most likely to have had a test for prostate cancer, followed by Medicaid-insured men. Further, both men and women who were privately insured were most likely to have had a colorectal cancer screening test. In all cases, uninsured individuals were least likely to have had any type of cancer screening.
Health insurance status is associated with other sociodemographic characteristics (e.g. race, level of education). However, when the data was analyzed by race, at every level of education, individuals with health insurance were about twice as likely as those without to have had mammography or colorectal cancer screening. Thus, having health insurance is an important predictor of cancer screening.
Insurance status, cancer stage at diagnosis and survival
ACS researchers also analyzed data from the National Cancer Data Base to investigate the relationship between insurance status, cancer stage at diagnosis and survival. In analyses of cancer survival for all cancers, uninsured individuals and Medicaid-insured individuals were 1.6 times more likely to die in 5 years than those with private insurance. Specifically, 35% of uninsured patients died in five years compared with 23% of privately insured patients. Since cancer screening tests are key to diagnosing and treating cancer in its early stages, not surprisingly people with health insurance were more likely to be diagnosed with early stage disease than individuals without insurance.
These results are consistent with previous studies showing that people who are uninsured or have Medicaid insurance are more likely to be diagnosed with late-stage cancer (breast and cancer of the mouth or throat, respectively) than people who are privately insured [3-4].
According to Dr. Otis Brawley, chief medical officer of the American Cancer Society :
This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services.
Research has shown that healthy lifestyle changes can prevent cancer. Additionally, advances in cancer detection and treatment have resulted in a decline in US cancer deaths in 2003 and 2004, the first decrease seen since 1930.
The American Cancer Society launched the Access to Care campaign in 2007. Access to Care is a national initiative dedicated to raising awareness about the predicament of uninsured and underinsured people in the United States. The campaign encourages Americans to find ways to fix the problem and make access to healthcare a national priority.
Ward et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008 Jan-Feb;58(1):9-31. Epub 2007 Dec 20.
- Hing and Burt. Characteristics of office-based physicians and their practices: United States, 2003-04. Series 13, No. 164. Hyattsville, MD: National Center for Health Statistics. 2007.
Halpern et al. Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer. 2007 Jul 15;110(2):403-11.
Chen et al. The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. Cancer. 2007 Jul 15;110(2):395-402.
- Report Links Health Insurance Status With Cancer Care. American Cancer Society News Center. 2007 Dec 20.