Journal Article
. 2018 Feb;96(50).
doi: 10.1097/MD.0000000000009125.

Disparities in quality of cancer care: The role of health insurance and population demographics

Arti Parikh-Patel 1 Cyllene R Morris  Kenneth W Kizer  
  • PMID: 29390313
  •     22 References
  •     11 citations


Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance.

A review of cancer outcomes among persons dually enrolled in Medicare and Medicaid.
Steven S Coughlin, Lee Caplan, Lufei Young.
J Hosp Manag Health Policy, 2018 Aug 14; 2. PMID: 30101216    Free PMC article.
Socioeconomic and patient-related factors for the management of male urethral stricture disease.
Ryan A Dornbier, Eric J Kirshenbaum, +4 authors, Christopher M Gonzalez.
World J Urol, 2019 Feb 28; 37(11). PMID: 30810835
Annual Report to the Nation on the Status of Cancer, Featuring Cancer in Men and Women Age 20-49 Years.
Elizabeth M Ward, Recinda L Sherman, +10 authors, Kathleen A Cronin.
J Natl Cancer Inst, 2019 May 31; 111(12). PMID: 31145458    Free PMC article.
Highly Cited.
Traumatic spinal cord injury in West Virginia: Disparities by insurance and discharge disposition from an acute care hospital.
Cara L Sedney, Uzer Khan, Patricia Dekeseredy.
J Spinal Cord Med, 2018 Dec 07; 43(1). PMID: 30508405    Free PMC article.
Decreasing mortality and hospitalizations with rising costs related to gastric cancer in the USA: an epidemiological perspective.
Delong Liu, Dhruv Mehta, +6 authors, Aparna Saha.
J Hematol Oncol, 2018 Dec 14; 11(1). PMID: 30545376    Free PMC article.
Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map.
Elzerie de Jager, Adele A Levine, +8 authors, Melinda A Maggard-Gibbons.
J Am Coll Surg, 2019 Feb 26; 228(3). PMID: 30803548    Free PMC article.
Systematic Review.
First-Line Systemic Treatments for Stage IV Non-Small Cell Lung Cancer in California: Patterns of Care and Outcomes in a Real-World Setting.
Frances B Maguire, Cyllene R Morris, +5 authors, Kenneth W Kizer.
JNCI Cancer Spectr, 2020 Apr 25; 3(3). PMID: 32328551    Free PMC article.
Annual report to the nation on the status of cancer, part II: Progress toward Healthy People 2020 objectives for 4 common cancers.
S Jane Henley, Cheryll C Thomas, +12 authors, Lisa C Richardson.
Cancer, 2020 Mar 13; 126(10). PMID: 32162329    Free PMC article.
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
Ryan J Ellis, Cary Jo R Schlick, +7 authors, Ryan P Merkow.
BMJ Qual Saf, 2019 Aug 02; 29(2). PMID: 31366576    Free PMC article.
Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer.
Felix V Chen, Tulay Koru-Sengul, +7 authors, Mark L Gonzalgo.
Urol Oncol, 2019 Aug 20; 37(12). PMID: 31420159    Free PMC article.
Relationship between Insurance Type at Diagnosis and Hepatocellular Carcinoma Survival.
Shoshana Adler Jaffe, Orrin Myers, +3 authors, Jean A McDougall.
Cancer Epidemiol Biomarkers Prev, 2019 Dec 05; 29(2). PMID: 31796525    Free PMC article.