Have you ever wondered if there’s a difference in cancer care between
private pay and Medicaid, the federal health plan for low-income
people? Now three new studies show that Medicaid patients appear to
receive worse cancer care than people with private insurance.
Those covered by Medicaid are less likely to have their cancer caught
at an earlier and more treatable phase; and the Medicaid patients also
are also more likely to die from cancer than people with private
insurance according to researchers.
There are a lot of factors that contribute to this such as lack of
experience in navigating the health care system, says an oncologist at
the Robert H. Lurie Comprehensive Cancer Center of Northwestern
University in Chicago.
“Research has shown that we can screen more patients, but that they get
dropped along the way to treatment. We don’t give them full access into
curative therapy,” says a spokeswoman for the American Society of
Clinical Oncology. “We need to do a better job to make sure that people
who aren’t savvy or can’t advocate for themselves have that helping
hand.”
The three studies each focused on a different type of cancer and how
insurance affects screening or care for patients; and the first study
was on done on Hodgkin lymphoma, with researchers from the University of
Tennessee reviewing data for 6,395 patients treated for the cancer
between 2007 and 2010.
The study revealed that doctors were more likely to catch the person’s
lymphoma at an earlier stage if they had private insurance. About 59
percent of people with private insurance received a diagnosis before
cancer had a chance to spread throughout their body, compared with 50
percent of Medicaid patients. And Medicaid patients were less likely to
receive radiation treatment. 35% of the Medicaid patients received
radiation compared to 43% of privately insured patients. And finally,
privately insured patients were more likely to survive. 84% percent
survived their lymphoma compared with 71 percent of Medicaid patients.
Results from the second study that involved cases of melanoma were
similar. Researchers at Case Western Reserve School of Medicine in
Cleveland reviewed data for 31,957 patients treated for melanoma between
1996 and 2009 in Ohio. They found that patients were two and a half
times likelier to be diagnosed with late-stage melanoma if they were
covered by Medicaid.
The final study regarded breast cancer. The researchers found that
women were less likely to receive medically advanced techniques for
diagnosing breast cancer if they had Medicaid or Medicare. Only 47
percent of Medicaid or Medicare patients received a breast MRI– compared
with 81 percent of those with private insurance.
The results from all studies were presented at the American Society of Clinical Oncology annual meeting in Chicago.
Patients often have trouble finding a doctor or hospital that
participates in Medicaid because the program traditionally has not paid
as well as Medicare or private insurance for medical services. And
Medicaid’s low-income enrollees have life problems that can hamper their
cancer care. Medicaid patients also tend to have more health problems
overall, which means they may put off cancer screening to focus on
chronic illnesses like heart disease or diabetes.
Currently, there are 4.8 million additional people that have joined
Medicaid or the Children’s Health Insurance Program since the Affordable
Care Act marketplaces opened in October 2013. Currently, a total 64.6
million low-income people are covered by the federal health insurance
programs.
Doctors hope that increased access to Medicaid under the Affordable Care
Act will improve the care patients receive. The law also includes a
provision that increases pay for Medicaid services, in an effort to draw
more doctors and hospitals to the program.
“What we’ve seen in Massachusetts is that lots more patients have
coverage,” said one doctor. “Many people who have been outside the
traditional health care system came into the system and began receiving
care, and I think that’s been good for them.”
But these new patients still face problems getting care for cancer.
Even those who receive cancer screening often fall through the cracks
before they can receive treatment.
Some doctors advocate the use of “nurse navigators” who can act as care
managers for Medicaid patients, steering their care and advising them
through the complex process of cancer treatment. The results were
presented at the American Society of Clinical Oncology annual meeting in
Chicago. “Simply paying for health care and actually showing people the
way forward are two different things,” Patel said.
So how do you feel about health care? Do you think the Affordable Care
Act is a good thing–or a bad thing? Do you know how will it affect you
personally?
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