An article published online yesterday in the American Cancer Society’s CA: A Journal for Clinicians which reviews in detail the relationship between health insurance (or lack thereof) and cancer outcomes has received a good deal of press attention over the past 24 hours.
The article, written by my colleagues from our Department of Epidemiology and Surveillance Research here at the Society, is an in-depth review of published research which correlates the presence or absence of adequate health insurance with access to cancer care, cancer screening, and cancer outcomes.
On a logical basis, the conclusions are not surprising.
As noted by the authors, “There is substantial evidence that lack of adequate health insurance coverage is associated with less access to care and poorer outcomes for cancer patients. As our nation’s investments in cancer research provide greater understanding of how to prevent cancer, detect it early, and treat it effectively, access to health care becomes even more important to the American Cancer Society’s goal of eliminating cancer as a major public health problem.”
The statistics in the article are mind numbing in their detail. They outline a system that is in fact a broken non-system of medical care, where those with adequate insurance and financial resources may wonder what the fuss is all about.
But if you take the time to read the article, you quickly see that we have serious problems in our health care system, particularly where it pertains to the early diagnosis and effective treatment of patients with cancer.
The authors acknowledge that “it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient-level, provider and health system factors. Even among individuals with adequate health insurance, variation in receipt of optimal care and outcomes can be observed by race and ethnicity, sex, age, income, education, urban versus rural area of residence, and other sociodemographic and geographic factors.”
The authors actually provide an extensive and detailed description (with many accompanying statistics and references) which summarizes the various health insurance options available today in the United States.
They also provide considerable information on the strengths and weaknesses of each of these insurance options, such as what can happen when a person loses a job, divorces, or has a spouse die. They also discuss the unfortunate reality that health insurance frequently is not adequate to provide effective coverage at times when people need it the most.
When it comes specifically to issues related to cancer, the authors point out clearly that health insurance relates to the probability of having a regular source of medical care, or medical home. This factor correlates directly with the likelihood of having counseling regarding lifestyle factors which can reduce the risk of cancer, or having access to appropriate cancer screening for prevention and early detection, such as is the case with colorectal cancer screening and mammography.
Ultimately, it is the outcomes that count. And this paper makes it very clear that no insurance or inadequate insurance or “too-late insurance,” such as the case for many people who receive Medicaid after their cancer is diagnosed, leads to later diagnosis and poorer survival.
I must admit that in this season of joy, happiness and optimism for a new year that reading this paper was exceptionally depressing.
I began to wonder how anybody can effectively navigate the health care system when they needed care, if it is so complicated, so expensive and so non-responsive to those in need.
But the evidence takes us to where we need to be, and for many people in this country, according to this research, this is their grim reality.
An editorial which accompanies the paper, written by the new American Cancer Society president Elmer Huerta, MD, comments on the relationship between the facts presented in the paper described above and the Society’s current advertising campaign regarding access to health care.
Dr. Huerta has experienced first hand the problems faced by those without health insurance.
He writes, “Some people will dispute or ignore these statistics, perhaps because of cognitive dissonance with their rosy internal image of health care in the United States. One prevalent misconception is that only the poorest of the poor have trouble accessing health care and that even these poorest Americans can received high quality care (albeit with a little inconvenience) through hospital emergency departments and a patchwork of public and private safety-net programs.”
Dr. Huerta continues, “The truth is that there are gaping holes in our health care safety net and that most of these safety-net services are neither effective nor efficient in providing chronic-disease prevention, detection or treatment. The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year and thousands more to die of other diseases. And for those who are unmoved by this shameful injustice, the data also show that for many hard-working, middle-class families, a diagnosis of cancer sets in motion a series of unfortunate events, including job loss, los of employer-based insurance, bankruptcy, and all too often, premature death.”
In this time of the year, when so many of us focus on the blessings we have and the joy of our families, perhaps it isn’t asking too much to reflect on the results of this research, and the moving comments of Dr. Huerta.
As we make our rounds of buying and giving gifts, and celebrating the year past and the year to come, we must be mindful that there are those among us who will be facing a season of little joy because of events that are frequently beyond their control. They may have lost a loved one to illness, or may be facing insurmountable medical debt, or can’t afford or gain access to adequate medical care at a time of need.
Somehow, that just doesn’t seem right, and maybe this is the best time to make a nationwide commitment to do something about it.