A Brighter Future? The Impact of Insurance and Socioeconomic Status on Cancer Outcomes in the USA: A Review

Abstract

Uninsured and Medicaid-insured cancer patients have been shown to present with more advanced disease, less often receive cancer-directed therapy and suffer higher rates of mortality than those with private insurance. The Patient Protection and Affordable Care Act was signed into law in March of 2010 and seeks to increase rates of public and private health insurance. Although several provisions will in particular benefit those with chronic and high-cost medical conditions such as cancer, the extent to which disparities in cancer care will be eliminated is uncertain. Further legislative changes may be needed to ensure equal and adequate cancer care for all patients regardless of insurance or socioeconomic status.

The experience of treatment barriers and their influence on quality of life in American Indian/Alaska Native breast cancer survivors

“…The current study differs from previous research, in that privately insured participants reported more barriers accessing treatment than Medicaid participants and experienced nearly the same number of mean barriers during treatment. In part, this is because many AI/ANs do not know how to use private health insurance, in that many have never had it.…”

“…An earlier review of the NACES data indicated that >54% of patients had difficulty accessing cancer care: Nearly one‐third of respondents reported that local clinics were unavailable to provide cancer care for them or that they encountered difficulty completing referral paperwork for care through Veterans Affairs and/or Medicaid . Other studies have demonstrated that uninsured individuals or those covered by Medicaid are more likely to have advanced cancers when presenting for treatment compared with privately insured individuals . Native patient navigators (NPNs) have emerged as a culturally congruent intervention to address known health care disparities in this vulnerable population.…”

Impact of socioeconomic status on survival of colorectal cancer patients

“…Delayed cancer screen may also affect the survival of cancer patients. Uninsured and Medicaid-insured cancer patients have been shown to present with more advanced disease, less often receive cancer-directed therapy and suffer higher rates of mortality than those with private insurance [ 16 ]. For CRC, lack of insurance is associated with an elevated risk of late-stage diagnosis and a decreased likelihood of undergoing screening and receiving treatment following a diagnosis [ 17 ].…”

Solid Organ Transplantation and Survival among Individuals with a History of Cancer

“…Because of the cost and complexity of organ transplantation, most transplant recipients have health insurance and access to advanced medical care, which is not the case for all US cancer patients. Socioeconomic and health insurance status have strong associations with cancer survival (21,22). Such differences between transplanted and untransplanted cancer patients may partly explain the inverse associations that we observed for some cancers, e.g., breast cancer (22,23).…”