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A new report by American Cancer Society researchers finds that Americans without adequate
health insurance are less likely to receive appropriate health care services. Specifically,
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 compared to
those who have private health insurance. The researchers say their report reveals the need
to address insurance barriers so that all Americans can benefit from advances in cancer prevention and treatment.
According to the report, advances in the prevention, early detection, and treatment of cancer have resulted
in a nearly 14% reduction in cancer deaths from 1991 to 2004, with significant decreases in the top three
causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in
women (breast and colorectal cancer). However, not all members of society have benefited from these
decreases in cancer deaths, particularly those without health insurance.
The researchers found many barriers to health care for those Americans who do not have private health insurance. These include:
- Some private physicians do not accept new patients unless they have private
insurance or are able to pay the full cost at the time of the visit
- Patients who are unable to afford outpatient care in private practice settings may seek care
in emergency departments, which are only required to determine if a medical emergency exists and then
refer patients for outpatient care that physicians refuse to provide
- Community programs, such as school- and church-based health clinics, private physicians, and nonprofit
hospitals, which serve uninsured Americans, can be understaffed, under-resourced, or lack the expertise
to adequately treat some patients.
To prepare their report, Elizabeth Ward, PhD, and her colleagues analyzed nearly 600,000 cancer cases using data from the
National Cancer Data Base. They found that uninsured cancer patients were 1.6 times as likely to die within 5 years
compared to cancer patients with private health insurance. Patients who did not have health insurance for 12 months
or longer were less likely to seek treatment for chronic conditions.
In terms of cancer screening, about 75% of women aged 40 to 64 years who had private health insurance reported
receiving a mammogram in the past 2 years compared with 56% of women with Medicaid insurance and only 38% of
uninsured women. Similarly, nearly 88% of women with private health insurance had Pap tests during the past
three years to screen for cervical cancer compared to nearly 83% of women with Medicaid insurance and
only 68% of uninsured women. Medicaid is a federal funded state-operated program that provides benefits
some health care benefits to low-income persons in need of care.
The report also notes that Americans without insurance are more likely to be diagnosed with later stage
cancers. The later the stage of cancer, the lesser the chances of successful treatment and survival. Among
women diagnosed with breast cancer in 1999 and 2000, for example, patients with private insurance were
more likely to be diagnosed with Stage I breast cancer and less likely to be diagnosed with Stage III
and IV cancer than those who were uninsured or had Medicaid insurance. The researchers note that possible
causes for later-stage diagnoses among uninsured Americans include less access to or participation in cancer screening tests.
In terms of cancer deaths, patients without insurance were more likely to die than those with insurance. Among
white patients with private insurance, 89% survived 5 years compared with 76% of patients who were uninsured
or had Medicaid insurance. Among African American women with private insurance, 81% survived 5 years compared
with 65% of uninsured patients and 63% of Medicaid-insured patients. Among Hispanic patients with private
insurance, 86% survived 5 years compared with 83% who were uninsured and 76% of those with Medicaid insurance.
The report highlights important disparities in health care access due to insurance status. While cancer prevention
and treatment advances continue to hold promise, not all Americans may be able to take advantage of these
advances unless greater access to screening, diagnosis, and treatment is made available to everyone. The
American Cancer Society is advocating making health care a national priority to improve access and decrease cancer deaths.
Additional Resources and References
- The report, Association of Insurance with Cancer Care Utilization and Outcomes, is to be
published in the January/February 2008 issue of CA: A Cancer Journal for Phyisicans. The study
was published online on December 20, 2007,
http://caonline.amcancersoc.org/cgi/content/full/CA.2007.0011v1
- The American Cancer Society provided information about this report on its website in a December 20, 2007
article entitled, Report Links Health Insurance Status With Cancer Care
http://www.cancer.org/
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