Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

Abstract

The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents’ regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancer specialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen a primary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). In addition, those with public (vs private) insurance were less likely to have a regular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likely to have made a primary care visit in the past year (OR = 2.8, 95% CI = 2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, and those with public (vs. private) insurance have less access to primary care. Policies that ensure continuity of coverage for survivors as they age into adulthood may result in fewer barriers to needed care, which may lead to fewer health problems for CCS in the future.

Differences in Perceived Waiting Time by Health Insurance Type in the Inpatient Sector: An Analysis of Patients With Breast Cancer in Germany

“…Health insurance coverage and type have been linked with differences in health outcomes, 1 patient experiences, 2 and health care accessibility and utilization. 3 Although one aim of universal health coverage in Germany is to provide equal access to health care and reduce health disparities, differences in health care access have been observed based on the type of health insurance patients have. 4-7 Health insurance in Germany can be categorized into 2 main schemes—statutory health insurance (SHI) and private health insurance (PHI)—and thus presents a unique case in examining differences in patient outcomes by insurance type.…”

Estimating cancer treatment intensity from SEER cancer registry data: methods and implications for population-based registry studies of pediatric cancers

“…Treatment intensity has been used to study adverse health events, health behaviors (e.g. substance use, healthcare utilization, information seeking), mental health, quality of life, self-efficacy, cancer-related knowledge, and resilience among pediatric cancer survivors [5][6][7][8][9][10][11][12][13][14][15][16]. This method could be applied to cases from other regions…”

Insurance coverage change and survivorship care among young adult survivors of childhood cancer

“…11 Access to survivorship care is influenced by insurance coverage, out-of-pocket costs, and lack of perceived need for survivorship care. [12][13][14] Furthermore, CCS are more likely to report forgoing or delaying care due to cost and lost annual productivity (e.g., loss of income). 13,15 Some survivors of lower socioeconomic status or those who recently transitioned from parental health insurance may face financial barriers to needed care.…”

“…16,17 Access barriers to survivorship care resulting in disparities for CCS have been documented by race, ethnicity, sex, socioeconomic status, insurance coverage, employment, education, and underserved or rural status. 4,14,[17][18][19][20][21] Barriers to survivorship occur at different levels such as patient, provider, caregiver/family members, health system, and payer. 21 Despite publication and adoption of survivorship care or longterm follow-up guidelines by organizations such as the Children's Oncology Group (COG), National Comprehensive Cancer Network, American Society of Clinical Oncology, American Society of Pediatric Hematology and Oncology, American Academy of Pediatrics (AAP), and others, many CCS still do not receive adequate survivorship care.…”

“…However, a significant number of cancer survivors (about 8%) remain uninsured or underinsured despite the policy changes enacted in the Patient Protection and Affordable Care Act aimed at decreasing insurance disparities 11 . Access to survivorship care is influenced by insurance coverage, out‐of‐pocket costs, and lack of perceived need for survivorship care 12–14 . Furthermore, CCS are more likely to report forgoing or delaying care due to cost and lost annual productivity (e.g., loss of income) 13,15 .…”