Health Insurance And Cancer Survival: The Convicting Reality
Posted by Lynne Eldridge MD at 12/21/2007 5:27 AM 
Categories: Universal Health Care, Cancer survival, Health Insurance, Presidential Candidates, Cancer Screening, Health Care
Categories: Universal Health Care, Cancer survival, Health Insurance, Presidential Candidates, Cancer Screening, Health Care
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.
_______________________________________________
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
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.
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.
_______________________________________________
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
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.
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.
Reply to this
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.
Reply to this
Cancer is the disease whose stages cannot be identified easily..It is like slow poison..The symptoms are rarely known..It is better to eat a healthy diet to avoid all these things...
Great post!!!!
Reply to this