Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.
People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.
The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say—even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.
The new research is being published in CA: A Cancer Journal for Clinicians, a cancer society publication. In an accompanying editorial, the society’s president repeated the organization’s call for action to fix holes in the health care safety net.
The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study’s lead author.
The researchers were not able to tell if the numbers were influenced by patients’ education levels, or by other illnesses.
Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.
“The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason,” said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn’t participate in the cancer society study.
The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.
A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment—or decided not to get it—because of the cost.
Chart shows screening percentages for breast and colon cancer; two sizes; 2c x 3 1/4 inches; 96.3 mm x 82.6 mm; 1c x 3 1/4 inches; 46.5 mm x 82.6 mm