Uninsured, Medicare, and Medicaid Patients Less Likely to Receive Surgical Cancer Care

Patients with breast, prostate, lung, or colorectal cancer who are uninsured or covered by Medicaid or Medicare insurance are less likely to receive surgical care at high-volume hospitals, according to a report.

“Underinsured patients face significant barriers in accessing high‐quality care. Evidence of whether access to high‐volume surgical care is mediated by disparities in health insurance coverage remains wanting,” the study authors stated.

To identify what disparities may exist, they queried the National Cancer Database on adults diagnosed with breast, prostate, lung or colorectal cancer between 2004 and 2016. They estimated the likelihood of receiving surgical care at a high-vo Unlume hospital based on insurance type with multivariable logistic regression analyses, performed for each type of cancer. This was followed with analyses of the interactions between study period and insurance status.

The database search yielded 1,279,738 patients eligible for study inclusion. When compared to patients with private insurance, the odds of receiving surgical care at high-volume hospitals were lower for breast cancer patients with Medicare (odds ratio [OR]=0.75; P<0.001) or Medicaid (OR=0.55; P<0.001), or who were uninsured (OR=0.50; P<0.001); prostate cancer patients with Medicare (OR=0.87; P=0.003) or Medicaid (OR=0.58; P=0.001), or who were uninsured (OR=0.36; P<0.001); and lung cancer patients with Medicare (OR=0.84; P=0.020) or Medicaid (OR=0.74; P=0.001), or who were uninsured (OR=0.48; P<0.001).

For colorectal cancer patients, outcomes varied by study period, with notable improvements beginning in 2011. From 2004 through 2007, colorectal cancer patients with Medicaid insurance had an OR of 0.51 for receiving surgical care at a high-volume hospital, and from 2014 through 2016, had an OR of 0.99 (P for interaction=0.001). Among uninsured colorectal cancer patients at the same timepoints, the ORs were 0.45 and 1.19, respectively, compared with private insurance patients (P for interaction<0.001).

The study was published in Cancer.

“Ultimately, if patients with private insurance get care at better hospitals, then they will have better outcomes. Policy needs to address these issues urgently, otherwise insurance-based disparities will persist or get worse,” said senior author Quoc-Dien Trinh, MD, of Brigham and Women’s Hospital, in a press release.