Friday, December 21, 2007

Health Insurance And Cancer Survival - The Convincing Reality

47 Million Uninsured = 47 Million More Likely To Die From Cancer

My friend David Kerns received this email "quote-of-the-day" from Don McCanne, a member of the Physicians for National Health Program. Many of us that practice or have practiced medicine have felt that a lack of health insurance is associated with an earlier demise. The American Cancer Society Research below lends numbers to that intuition.

I personally recall one special patient that yanks at my heart strings from beyond each time I think of the large number of working uninsured. She lived with symptoms suggestive of cancer for seven years before consulting me - after she knew she had lost the battle of deciding whether to make house payments for her modest home, or purchase health insurance.

The December 20, 2007 American Cancer Report Links Health Insurance Status With Cancer. Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts, according to a new American Cancer Society report examining the impact of health insurance status on cancer treatment and survival.

American Cancer Society researchers analyzed 598,635 cases using the most recent data from the National Cancer Data Base, a hospital-based registry held by the Commission on Cancer of the American College of Surgeons. The registry tracks approximately 70% of the cancer cases in the United States and collects data from about 1,500 hospitals. The patients included had either private insurance, Medicaid, or no insurance. The researchers also examined data from the 2005 and 2006 National Health Interview Survey, a nationwide in-person survey of approximately 40,000 U.S. households conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC).

For all cancers combined, the researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance. People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense. Individuals with health insurance were about twice as likely as those without to have had a recent mammogram or cancer screening. People with insurance were also more likely to be diagnosed with early stage disease and less likely to be diagnosed with advanced stage disease than the uninsured. The researchers saw a survival difference in breast and cancer, too. About 89% of privately insured white women with breast cancer survived at least 5 years, compared to 76% of white women with Medicaid or no insurance. Among African-American women, 81% of breast cancer patients with private insurance survived 5 years, compared to 65% of those on Medicaid and 63% of those without insurance.

A similar pattern emerged in colorectal cancer. Among white patients with private insurance, 66% survived 5 years, compared to 50% of those with no insurance and 46% of those on Medicaid. Among African Americans, 60% with private insurance survived 5 years compared to 41% of the uninsured and Medicaid patients. The risk of being uninsured or underinsured varies. Almost anyone can be undrerinsured in the event of a major illness. Underinsured, commonly defined as people who spend more than 10% of their after-tax household income on out-of-pocket expenses in the event of a serious illness, often don't realize the gravity of their situation until faced with high premiums and deductibles, limits on terms for covered services, and caps on monthly, lifetime, or disease- specific coverage.

According to a 2003 study sponsored by the Agency for Health Care Research and Quality, the prevalence of being underinsured increased from 6.7% to 8.5% among nonelderly adults between 1996 and 2003. These numbers shot up when the costs of health insurance premiums were factored in. Among people with cancer, 29% had out-of-pocket expenses that exceeded 10% of their family's income and about 11% exceeded it by 20% http://www.cancer.org/docroot/NWS/content/ _1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp"

Association of Insurance with Cancer Care Utilization and Outcomes" January/February 2008 issue of CA: A Cancer Journal for Clinicians, published by the American Cancer Society:http://caonline.amcancersoc.org/Quote-of-the-day@mccanne.orghttp://two.pairlist.net/mailman/listinfo/quote-of-the-day

As the 2008 election approaches, health care is a central issue. Both parties see a need, from a Democratic candidate promising universal health care, to a Republican candidate that met a need to insure all children in Arkansas. The issue rouses complex issues in political philosophy - but one thing remains the same. Cost is an issue. Hopefully, we will see a movement that emphasizes prevention, lowering the risk that individuals will develop chronic diseases - illnesses responsible for 70 percent of health care costs, and free up money so that patients, such as my patient, "Mrs. Failedbythesystem" above, can be insured.

My friend, David Kerns, the author of "Standard of Care", a heartwrenchingly honest yet fictional portrayal of the ethical dilemas in our current health care system, can be visited at http://www.davidkerns.com/.

For information on cancer prevention, buy Avoiding Cancer One Day At A Time.