Cancer Patient Outcomes Significantly Worse for the Uninsured

May 19, 2021 - Patient outcomes are significantly worse in cancer patients who do not have insurance compared to insured patients, according to Gerard Silvestri, MD, professor of medicine and a lung cancer pulmonologist at the Medical University of South Carolina (MUSC) and researcher at the MUSC Hollings Cancer Center.

The conclusions of this study are relevant to policy considerations around lowering the Medicare coverage age of eligibility.

 Silvestri started by looking at lung cancer patients and their outcomes based on their insurance status and age. The results spurred the researchers to look further into the survival rates for the 16 most common types of cancer.

The researchers distributed patients into four different groups of uninsured patients 60 to 64 years old, private insurance patients 60 to 64 years old, Medicare patients 60 to 69 years old, and Medicare plus private insurance patients 66 to 69 years old.

It was clear from the findings that one of these groups had a disadvantage.

Uninsured patients 60 to 64 years old had significantly worse outcomes with all 16 cancers than the other patients, Silvestri found. Typically, younger cancer patients have a better survival rate, but a lack of insurance changes that trend.

“Further, there was a dose response gradient across the different insurance groups. Uninsured younger patients had the lowest survival, followed by older Medicare patients without supplemental private insurance, then older Medicare patients with supplemental private insurance, with younger privately insured patients have the best survival. The survival difference was quite surprising,” said Silvestri.

Economic stability, one of the five social determinants of health domains, can be the difference between life and death when it comes to a disease like cancer. Patients who cannot afford insurance and who are below the required age for Medicare do not always have the funds for necessary, life-saving treatments.

Uninsured patients are more likely to delay medical care and avoid screenings due to the cost, which can result in patients leaving a disease untreated until it is too late.

Medicare Advantage has provided seniors with lower costs and higher quality of care. In recent years, six in ten Medicare Advantage members did not have a premium and they also had lower healthcare costs.

According to an Alliance of Community Health Plans fact sheet, 99 percent of Medicare Advantage members were satisfied with their health plan and 78 percent of members were in a plan that was rated four stars or higher.

Expanding Medicare coverage to the 60 to 64 age bracket could have a significant effect on uninsured cancer patients and increase their chances of survival.

An American Cancer Study report highlighted the many different cost requirements that come with cancer treatment, including drug costs, imaging tests, hospital costs, and surgery. Uninsured patients not only have to worry about their cancer, but they also need to juggle the higher cost burden that comes with it.

In 2020, 43 percent of working-age adults were uninsured, underinsured, or fell into a coverage gap, according to a Commonwealth Fund study. Expanding Medicaid has the possibility to help people who have too high of an income for Medicaid eligibility but too low of an income to qualify for subsidies on the marketplace.

Although the Commonwealth Fund study reports on people below the 60 to 64 age group, people with insurance are more likely to seek medical care and their chances of catching any possible cancers at an early stage increases.

Whether it be expanding Medicaid and Medicare to reach more people in need of insurance or lowering costs to both private insurances and marketplace health plans, providing easier access to care for patients can save lives and drastically improve patient outcomes.