A Denial a Day Keeps the Doctor Away

Dunn, Abe; Gottlieb, Joshua D.; Shapiro, Adam Hale; Sonnenstuhl, Daniel J.; Tebaldi, Pietro

doi:10.3386/w29010

Cited by 25 publications

(16 citation statements)

References 50 publications

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“…That study also found that a more important mediator of survivability was the stage of diagnosis. In context with our findings, if private or Medicare insurance coverage was expanded or if Medicaid eased the administrative burden physicians face, far fewer women from racial and ethnic minority groups would receive a diagnosis of advanced-stage cancer and, thus, would have a higher survivability.…”

Section: Discussionsupporting

confidence: 65%

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

et al. 2023

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ImportanceBlack and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer. Health insurance coverage is associated with diagnosis at an earlier stage of cervical cancer.ObjectiveTo evaluate the extent to which racial and ethnic differences in the diagnosis of advanced-stage cervical cancer are mediated by insurance status.Design, Setting, and ParticipantsThis retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results (SEER) program on an analytic cohort of 23 942 women aged 21 to 64 years who received a diagnosis of cervical cancer between January 1, 2007, and December 31, 2016. Statistical analysis was performed from February 24, 2022, to January 18, 2023.ExposuresHealth inusurance status (private or Medicare insurance vs Medicaid or uninsured).Main Outcomes and MeasuresThe primary outcome was a diagnosis of advanced-stage cervical cancer (regional or distant stage). Mediation analyses were performed to assess the proportion of observed racial and ethnic differences in the stage at diagnosis that were mediated by health insurance status.ResultsA total of 23 942 women (median age at diagnosis, 45 years [IQR, 37-54 years]; 12.9% were Black, 24.5% were Hispanic or Latina, and 52.9% were White) were included in the study. A total of 59.4% of the cohort had private or Medicare insurance. Compared with White women, patients of all other racial and ethnic groups had a lower proportion with a diagnosis of early-stage cervical cancer (localized) (American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 49.9%; Black, 41.7%; Hispanic or Latina, 51.6%; and White, 53.3%). A larger proportion of women with private or Medicare insurance compared with women with Medicaid or uninsured received a diagnosis of an early-stage cancer (57.8% [8082 of 13 964] vs 41.1% [3916 of 9528]). In models adjusting for age, year of diagnosis, histologic type, area-level socioeconomic status, and insurance status, Black women had higher odds of receiving a diagnosis of advanced-stage cervical cancer compared with White women (odds ratio, 1.18 [95% CI, 1.08-1.29]). Health insurance was associated with mediation of more than half (ranging from 51.3% [95% CI, 51.0%-51.6%] for Black women to 55.1% [95% CI, 53.9%-56.3%] for Hispanic or Latina women) the racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer across all racial and ethnic minority groups compared with White women.Conclusions and RelevanceThis cross-sectional study of SEER data suggests that insurance status was a substantial mediator of racial and ethnic inequities in advanced-stage cervical cancer diagnoses. Expanding access to care and improving the quality of services rendered for uninsured patients and those covered by Medicaid may mitigate the known inequities in cervical cancer diagnosis and related outcomes.

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Section: Discussionsupporting

confidence: 65%

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

et al. 2023

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“…Whether all mental health care will be covered under this provision has not yet been determined. Other policy solutions are needed to retain (and recruit) practitioners in networks, possibly through reimbursement and a reduction in administrative burden . The high rate of denials of claims for mental health treatment under private insurance suggests this may be a relevant factor underlying low participation among mental health practitioners …”

Section: Discussionmentioning

confidence: 99%

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Busch

Kyanko

2021

JAMA Netw Open

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IMPORTANCE Ten years after the Mental Health Parity and Addiction Equity Act, patients continue to report insurance-related barriers to specialty mental health care.OBJECTIVES To assess privately insured patients' perceptions of the adequacy of their health plan's provider network (provider network includes physicians, clinicians, other health care professionals, and their institutions that constitute the network), whether practitioners frequently leave plans, and whether practitioner plan participation affected patients' plan choice. DESIGN, SETTING, AND PARTICIPANTSA nationally representative, population-based internet survey study of English-speaking US adults participating in KnowledgePanel, an online research panel, was conducted from August to September 2018. Data analysis was performed from November 12, 2020, to May 12, 2021. From a sample of 29 854 panelists aged 18 to 64 years, 19 602 initiated the screener (completion rate of 66%), and 728 met study criteria: adults with private insurance receiving both specialty mental health and medical care in the past year.EXPOSURE Health plan's provider network. MAIN OUTCOMES AND MEASURESSelf-report of plan inadequacy, whether a practitioner left the plan and the participant's responses (stopped treatment, switched practitioner, or continued treatment), and whether participation of a specific practitioner was considered when a health plan was chosen. Experiences with both mental health and medical provider networks were assessed.Analyses were weighted to match the sample to the US population. Weights provided by KnowledgePanel were also adjusted for panel recruitment, attrition, oversampling, and survey nonresponse. RESULTSOf a total of 728 study participants, 204 (39%) were aged 18 to 34 years, 504 (61%) were women, 82 (17%) were Hispanic, and 551 (66%) were non-Hispanic White individuals. Serious psychological distress was reported by 262 participants (36%), and 214 participants (29%) also received mental health treatment from a primary care practitioner. Participants rated their mental health provider network as inadequate more frequently than their medical provider network ( 163[21%] vs 70 [10%]; odds ratio [OR], 2.69; 95% CI, 1.64-4.40; P < .001). However, among the 193 participants also receiving mental health treatment from a primary care practitioner, there was no significant difference in the ratings of mental health and medical provider networks (44 [14%] vs 18[9%]; OR, 1.55; 95% CI, 0.65-3.67; P = .32). Sixty participants (8%) reported that a mental health practitioner had left their plan's insurance network in the past 3 years. Of the 523 participants with a choice of plan, 98 (20%) considered whether a specific mental health practitioner was in network before choosing a plan. (continued) Key Points Question How do patient perceptions of mental health networks differ from perceptions of medical networks? Findings In this survey study of 728 US adults with private insurance receiving both specialty mental health and medical care, participants were signif...

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“…Germany 16% of the claims submitted are rejected and eventual indemnifications average only 63% of initial claims. Similarly, Dunn et al (2021) report that insurers deny (at least partially) 25% of Medicaid claims, while Briggs and Tonetti (2022) find that consumers expect to receive only a fraction of the promised payout for annuity, life and long-term care insurance.…”

Section: Nonperformance Riskmentioning

confidence: 99%