Survival outcomes for head and neck patients with Medicaid: A health insurance paradox

Abstract

Purpose Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. Methods A cohort of 18–64‐year‐old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007–2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC‐specific mortality. Results Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non‐Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. Conclusion Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.

Impact of Medicaid Expansion on Rhinologic Cancer Presentation, Treatment, and Outcomes

“…Another potential explanation involves the “Medicaid paradox.” This phenomenon, previously reported among head and neck cancer patients, 24 counterintuitively suggests that Medicaid patients do not have superior rates of survival compared to those who are uninsured. One report claims that Medicaid patients are 9% more likely to die from head and neck cancer compared to uninsured patients 24 .…”

“…Another potential explanation involves the “Medicaid paradox.” This phenomenon, previously reported among head and neck cancer patients, 24 counterintuitively suggests that Medicaid patients do not have superior rates of survival compared to those who are uninsured. One report claims that Medicaid patients are 9% more likely to die from head and neck cancer compared to uninsured patients 24 . This adverse association with Medicaid may be attributed to various comorbidities that are more prevalent among the Medicaid population, such as smoking and obesity, as well as lower socioeconomic status in Medicaid patients compared to the uninsured 25 .…”

“…One report claims that Medicaid patients are 9% more likely to die from head and neck cancer compared to uninsured patients. 24 This adverse association with Medicaid may be attributed to various comorbidities that are more prevalent among the Medicaid population, such as smoking and obesity, as well as lower socioeconomic status in Medicaid patients compared to the uninsured. 25 Only a minority of uninsured patients actually fall below the poverty line, and nearly half make 200% of the federal poverty line, 14 which disqualifies them from Medicaid eligibility.…”

Evidence‐Based Medicine in Otolaryngology, Part XIII: Health Disparities Research and Advancing Health Equity

“…97 Attention to patient context allows for more accurate framing of health disparities and risk factors and how they interact with health care policy and delivery systems. 22,29,92,98-100 Thus, structural competency and cultural humility allow the clinician to gain a deeper understanding of systemic factors that contribute to health inequities and to identify and address factors outside the clinical encounter that have profound impacts on treatment and health outcomes.…”

“…The awareness of the impact of sociodemographic factors such as race/ethnicity, insurance status, and SES on health outcomes can promote structural competency: the ability to discern how the complex interactions between social determinants of health and the structure of social‐economic systems influence health status, health‐related attitudes and behaviors, and disease states 97 . Attention to patient context allows for more accurate framing of health disparities and risk factors and how they interact with health care policy and delivery systems 22,29,92,98–100 . Thus, structural competency and cultural humility allow the clinician to gain a deeper understanding of systemic factors that contribute to health inequities and to identify and address factors outside the clinical encounter that have profound impacts on treatment and health outcomes.…”