This paper explores the statistical data related to health insurance and cancer survival rates. A description of different health insurance options is covered, as well as disparities that are associated with these choices. It attempts to make the connection between certain demographic groups and their health insurance options and eventual choices and how these individuals fared if ever diagnoses with cancer. Most studies outlines in this paper studied more than one type of cancer so as to provide a clearer picture from many angles. Introduction.
There has long been suspicion that the correlation between health insurance and better health care are undeniable. In reality, not only is the presence of insurance believed to allow the patient to fare better, but the better the insurance, the better the outcome. Generally, insurance is provided either through employer-based programs, government programs (i. e. Medicare, State Children’s Health Insurance Plan, Medicaid, etc. ) or private (nongroup) insurance (Ward, Halpern, Schrag, Cokkinides, DeSantis, Bandi, Siegel, Stewart and Jemal, 2008).
Insurance Descriptions Employer-Based With employer-based programs, participants are either employees of a company or a family member of an employee of a company. In 2006, 62% of insured individuals obtained insurance through their employers. While employer-based insurance plans offer some advantages, there are some serious disadvantages to these plans. Not all employees choose to participate, whether it is purely by choice or because of inability to pay, which could lead to problems should these employees be diagnosed with cancer.
Most tragically, if the insured employees do develop cancer, they may be at risk of losing their employment which of course would lead to losing their health insurance. The Consolidated Omnibus Budget Reconciliation Act, or COBRA, leaves them with an often unaffordable option to maintain health insurance. It is usually very costly, particularly when one factors in their loss of income from the unemployment (Ward, et al, 2008). Government Programs Medicare For most Americans over 65 years of age, Medicare is the automatic health insurance option, given they’ve paid into Medicare for at least 10 years.
Upon their 65th birthday, enrollment in Medicare Part A is automatic if the individual is eligible for social security benefits (Ward, et al. , 2008). Medicare Part A only covers hospital visits, which warrants the need or Medicare Part B. Part B covers physician services, diagnostic tests, outpatient care, specific preventative services and more. Part B, as it offers many more comprehensive services, also comes with a cost. There is a monthly premium associated with Part B that members are responsible for paying out of pocket.
There are also Parts C and D, which further expand benefits for those individuals who wish to pay for them. The federal government sets the Medicare deductibles on a yearly basis. This deductible covers the first 60 days of care. Upon the 61st day, Medicare recipients are required to pay an increasing percentage of the total cost of care (Ward, et al. , 2008). In instances where an individual is diagnosed with cancer, this cost could become exceedingly high. Medicaid Low-income individuals can qualify for Medicaid, which is a federally aided and state administered program.
Although the federal guidelines call for certain populations (i. e. children, pregnant women, elderly, disabled) to be eligible, states can also set their eligibility standards. The group most likely to have Medicaid coverage is children under 18. Women are more likely to be Medicaid recipients than men. Adults aged 45-64 range from 5% for White men to 15% for African-American and Hispanic women (Ward, et al, 2008). Medical assistance for women who are screened through the National Breast and Cervical Cancer Early Detection Program is due largely to the Breast and Cervical Cancer Prevention Act of 2000.
The assistance is provided through Medicare. Because of inadequate funding, however, only 13. 2% of eligible women received a mammogram in 2002/2003 (Ward, et al, 2008). State Children’s Health Insurance Program (SCHIP) SCHIP was established in 1997 by Congress to expand the coverage of low-income children. All 50 states and the District of Columbia have plans in place but coverage varies from state to state. Any family with children who fall below 200% of the federal poverty level are eligible for either SCHIP or Medicaid (Ward, et al, 2008).
Private, Nongroup Health Insurance Less than 5% of adults opt for private, nongroup health insurance. The reasons can vary but the main reason the participation percentage is low is because of the incredibly expensive rates for this type of insurance. A survey dating back to 2004 showed that 54% of adults with private health insurance paid approximately $3,600 each year to maintain these types of policies. For those individuals with pre-existing health conditions, this type of coverage can be astronomical. Stage at Diagnosis.
Stage at diagnosis is recorded using the American Joint Committee on Cancer’s staging system (0, I, II, III, IV) (Roetzheim, Chirimos, Wells, McCarthy, Ngo, Li, Drews and Iezzoni, 2008). The time frame in which an individual is diagnosed with cancer is nearly as important as the treatment that is subsequently received. Given that those individuals diagnosed at an earlier stage generally fare better than those who are diagnosed at a later stage, knowing “sooner rather than later” is an important objective to improving cancer outcomes (Roetzheim, Pal, Tennant, Voti, Ayanian, Schwabe and Krischer, 1999).
Studies have shown certain demographic trends with regard to stage at diagnosis. Interestingly, race and ethnicity, socioeconomic status and marital status all play a role in when a person was diagnosed with cancer. It is also noted that those who are part of health maintenance organizations have a more favorable stage at diagnosis, whereas those individuals who have Medicaid or no insurance tend to be diagnosed at much later stages (Roetzheim, et al, 1999).
One likely explanation for these observed survival differences is “lead-time bias”. Lead time bias occurs when cancer is detected at an earlier stage, thus giving the appearance of a longer survival time even if it doesn’t really exist (Bradley, Gardiner, Given and Roberts, 2005). Roetzheim, et al, examined four types of cancer (prostate, breast, colorectal and melanoma) and found that the presence and type of health insurance made a statistically significant difference in regard to stage at diagnosis (Roetzheim, et al, 1999).
Specifically, it noted that those individuals without health insurance have a severe lack of access to adequate cancer-screening services. Without provision of health care to all individuals, the uninsured will undoubtedly suffer less favorable outcomes for cancer (Roetzheim, et al, 1999). The symptoms associated with laryngeal cancer include hoarseness, otalgia and voice changes. In the absence of health insurance, it is clear to see why an individual experiencing these symptoms would not seek health advice. Of course the symptoms would worsen and they would present.
They would likely be staged at a much higher with worse survival rates and fewer treatment options (Chen, Schrag, Halpern, Stewart and Ward, 2007). Is This Health Insurance Disparity Related to Anything in Particular? Good health insurance is a precious commodity. It might be convenient to believe that all individuals have great coverage. The reality is that certain demographic groups simply cannot afford (for a variety of reasons) better or any coverage. Compared to more affluent groups, the comorbidity rate among poor people is significant (McDavid, Tucker, Slogett, and Coleman, 2003).
There is even evidence that Medicaid-insured and uninsured women with breast cancer had a similar death risk (Bradley, et al, 2004) which turned out to be significantly higher than women with private insurance. Many studies have determined that race plays a large role in differentials in health insurance coverage. For instance, the numbers of African-American Medicaid recipients is greater than Whites. Additionally, African-Americans have a greater risk of developing and dying of cancer and often receive poorer-quality treatment and have lower survival rates than their White counterpart (Ward, et al, 2007).
In 2005, 34% of 40. 8 million Hispanics were uninsured compared to 19% out of 11. 8 million Asian/Pacific Islander populations (Ward, et al, 2008). Advanced disease diagnosis has been found to occur in persons who fit the following demographic factors: gender (women were at higher risk); age (younger women were at risk); race (African-Americans were at higher risk); treatment facility type (teaching/research facilities had higher risks); and residence in zip codes with a high ratio of non-high school diploma holders and lower income individuals (Chen, et al, 2007).
Given this data, it does indeed appear that certain demographics face a serious gap in health insurance opportunities. Is One Better Than the Other? When making comparisons of Fee-for-Service (FFS) versus Health Maintenance Organization (HMO), it was noted that patients with HMO coverage fared better in a number of ways. First, cancer survival diagnosis usually comes earlier which can better an individual’s chances of longer survival.
As it turns out, screening for cancer occurs more often with HMOs and therefore, is usually caught earlier. This high rate of preventative care helps them move further away from the need for subspecialty care (Roetzheim, et al, 2008). In a study that followed Medicare recipients with disabilities, it was found that of the ones who had HMOs were also more frequently treated with breast conserving surgery with a follow-up of radiation therapy. Therein lies another sign that better insurance gets you better service.
So…the Verdict? Apparently, there is indeed a connection between whether or not an individual has insurance and the type of insurance that individual holds and the rate of survival once cancer is diagnosed. Higher mortality rates observed among the uninsured have been noted. In fact, in a study conducted on stage at diagnosis of laryngeal cancer, it was found that those individuals with no insurance or with Medicaid typically presented with advanced laryngeal cancer (Chen, et al, 2007).
In yet another study, patients with breast carcinoma had higher mortality rates if they were uninsured or had Medicaid (Roetzheim, et al 1999). In a study that employed scripted interviewers to place phone calls to make follow-up appointments for serious medical conditions, it was found that those who claimed to have private health insurance were given appointments sooner than those without. In the laryngeal cancer study, it was concluded that health insurance was an “important predictor” of advanced stage and larger tumors (Chen, et al, 2007).
Using the Facility Oncology Registry Data Standards (FORDS) data element for primary payer/insurance information at diagnosis, the study’s facilitators were able to group the study participants based on the type of insurance (or lack thereof) and make determinations regarding cancer survival (Chen, et al, 2007). Conclusion Based on a number of studies on the effect, if any, lack of or less than desirable health insurance had on cancer survival success, it is apparent that there is a correlation. Whether it be a comparison within the continental United States or one with the U.
S. and Canada, one can see that there is a clear cut case of the “haves” outlasting the “have nots”. Fee-for-Service doesn’t have a better arrangement than HMOs and those living in lower income neighborhoods don’t get the best that medicine has to offer. Ultimately, to consider this country’s ranking in taking good and fair care of its citizens, this gap will need to be closed so that everyone is on the same level of the playing field.
References Bradley CJ, Gardiner J, Given CW, Roberts C. Cancer, Medicaid enrollment, and survival disparities.
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