47 Million Uninsured = 47 Million More Likely To Die From Cancer

My friend David Kerns received this email "quote-of-the-day" from Don McCanne, a member of the Physicians for National Health Program.  Many of us that practice or have practiced medicine have felt that a lack of health insurance is associated with an earlier demise.  The American Cancer Society Research below lends numbers to that intuition.

I personally recall one special patient that yanks at my heart strings from beyond each time I think of the large number of working uninsured.  She lived with symptoms suggestive of cancer for seven years before consulting me - after she knew she had lost the battle of deciding whether to make house payments for her modest home, or purchase health insurance. 

American Cancer Society
December 20, 2007
Report Links Health Insurance Status With Cancer Care

Uninsured Americans are less likely to get screened for cancer, more 
likely to be diagnosed with an advanced stage of the disease, and 
less likely to survive that diagnosis than their privately insured 
counterparts, according to a new American Cancer Society report 
examining the impact of health insurance status on cancer treatment 
and survival.

American Cancer Society researchers analyzed 598,635 cases using the 
most recent data from the National Cancer Data Base (NCD, a 
hospital-based registry held by ACS and the Commission on Cancer of 
the American College of Surgeons. The NCDB tracks approximately 70% 
of the cancer cases in the United States and collects data from about 
1,500 hospitals. The patients included had either private insurance, 
Medicaid, or no insurance. The researchers also examined data from 
the 2005 and 2006 National Health Interview Survey (NHIS), a 
nationwide in-person survey of approximately 40,000 U.S. households 
conducted by the National Center for Health Statistics (NCHS) of the 
Centers for Disease Control and Prevention (CDC).

For all cancers combined, the ACS researchers found that uninsured 
patients were 1.6 times as likely to die within 5 years compared to 
individuals with private insurance.

People with lower incomes were less likely to have insurance, the 
report found. And those without insurance were less likely to use 
certain health services. About 54% of uninsured patients aged 18 to 
64 did not have a usual source of health care. About 26% delayed care 
due to cost, while nearly 23% did not get care because of cost. An 
estimated 23% did not get prescription drugs because of the expense.

Individuals with health insurance were about twice as likely as those 
without to have had a recent mammogram or colorectal cancer 
screening. People with insurance were also more likely to be 
diagnosed with early stage disease and less likely to be diagnosed 
with advanced stage disease than the uninsured.

The researchers saw a survival difference in breast and colorectal 
cancer, too. About 89% of privately insured white women with breast 
cancer survived at least 5 years, compared to 76% of white women with 
Medicaid or no insurance. Among African-American women, 81% of breast 
cancer patients with private insurance survived 5 years, compared to 
65% of those on Medicaid and 63% of those without insurance. A 
similar pattern emerged in colorectal cancer. Among white patients 
with private insurance, 66% survived 5 years, compared to 50% of 
those with no insurance and 46% of those on Medicaid. Among African 
Americans, 60% with private insurance survived 5 years compared to 
41% of the uninsured and Medicaid patients.

The risk of being uninsured or underinsured varies.

Almost anyone can be underinsured in the event of a major illness. 
The underinsured, commonly defined as people who spend more than 10% 
of their after-tax household income on out-of-pocket expenses in the 
event of a serious illness, often don't realize the gravity of their 
situation until faced with high premiums and deductibles, limits on 
terms for covered services, and caps on monthly, lifetime, or disease-
specific coverage.

According to a 2003 study sponsored by the Agency for Health Care 
Research and Quality, the prevalence of being underinsured increased 
from 6.7% to 8.5% among nonelderly adults between 1996 and 2003. 
These numbers shot up when the costs of health insurance premiums 
were factored in. Among people with cancer, 29% had out-of-pocket 
expenses that exceeded 10% of their family's income and about 11% 
exceeded it by 20%.

http://www.cancer.org/docroot/NWS/content/
NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp

"Association of Insurance with Cancer Care Utilization and Outcomes" 
January/February 2008 issue of CA: A Cancer Journal for Clinicians, 
published by the American Cancer Society:
http://caonline.amcancersoc.org/

Comment:  There are many factors that influence access and outcomes 
for cancer patients. This comprehensive study confirms that insurance 
status is one of the most important factors. The uninsured are 
screened less frequently; they are diagnosed at a later stage, and 
they have a lower survival rate.

Because of socioeconomic and other factors, insuring everyone will 
not eliminate these disparities. But financial barriers perpetuate 
and intensify the disparities. The crucial first step to improve 
health care for cancer patients (and for all other patients) is to 
remove financial barriers by including everyone in a comprehensive 
national health insurance program.

This study raises another important issue. Not only is insurance 
coverage crucial, the nature of that coverage counts as well.

Somewhat shocking is that the survival of Medicaid patients in this 
study was no better than that of the uninsured. Part of this is 
likely due to the reality that Medicaid is a chronically underfunded 
medical welfare program. Many health care providers refuse to accept 
Medicaid patients. Using Medicaid to reduce financial barriers is of 
little help when the health care delivery system has shut its doors 
to those enrolled in the program.

Another factor that may result in a lower survival rate for Medicaid 
patients is that many were previously uninsured or lost the coverage 
they had, so they use Medicaid as rescue coverage, inevitably 
entering the system at a later stage of their disease. But this only 
further confirms that it is not an adequate substitute for continuous 
comprehensive coverage that provides sufficient funding for the 
health care delivery system.

Another important reason that universal insurance coverage alone is 
not enough is that underinsurance has become a source of financial 
hardship, precisely for those with significant health care needs such 
as cancer patients. Not only does underinsurance create a hardship, 
it also is a barrier to care when the patient cannot afford his/her 
expensive chemotherapy because it isn't covered by the plan.

Medical welfare programs and inadequate coverage can never patch the 
vast holes in our health care system. Again, there is much to be 
done, but all other efforts will be relatively feeble until we remove 
financial barriers to care for everyone by enacting a single payer 
national health insurance program. That's the easy step. Then we need 
to go to work.
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As the 2008 election approaches, health care is a central issue. Both parties see a need, from a Democratic candidate promising universal health care, to a Republican candidate that met a need to insure all children in Arkansas.  The issue rouses complex issues in political philosophy - but one thing remains the same.  Cost is an issue.  Hopefully, we will see a movement that emphasizes prevention, lowering the risk that individuals will develop chronic diseases - illnesses responsible for 70 percent of health care costs, and free up money so that patients, such as my patient, "Mrs. Failedbythesystem" above, can be insured.


My friend, David Kerns, the author of "Standard of Care", a heartwrenchingly honest yet fictional portrayal of the ethical dilemnas in our current health care system, can be visited at www.davidkerns.com.

For information on cancer prevention, visit our website at www.avoidcancernow.com.