Cancer Outcomes Among Medicare Beneficiaries And Their Younger Uninsured Counterparts, Health Affairs, May 2021, by Gerard Silvestri, Ahmedin Jemal, K. Robin Yabroff, Stacey Fedewa, and Helmneh Sineshaw
Abstract: Proposals for expanding Medicare insurance coverage to uninsured Americans approaching the Medicare eligibility age of sixty-five has been the subject of intense debate. We undertook this study to assess cancer survival differences between uninsured patients younger than age sixty-five and older Medicare beneficiaries by using data from the National Cancer Database from the period 2004–16… We found that uninsured patients ages 60–64 were nearly twice as likely to present with late-stage disease and were significantly less likely to receive surgery, chemotherapy, or radiotherapy than Medicare beneficiaries ages 66–69, despite lower comorbidity among younger patients. Compared with older Medicare patients, younger uninsured patients had strikingly lower five-year survival across cancer types. For instance, five-year survival in younger uninsured patients with late-stage breast or prostate cancer was 5–17 percent lower than that among older Medicare patients. We conclude that… expanding comprehensive health insurance coverage to people approaching Medicare age eligibility may improve cancer outcomes in the US.
Comment:
By Isabel Ostrer, M.D.
Cancer is a leading cause of death in the United States. However, there are stark disparities in cancer outcomes among different populations. Lack of insurance is an unfortunate and unnecessary contributor to these disparities.
In this Health Affairs paper, we learn that uninsured patients ages 60-64 with a new cancer diagnosis had significantly worse one-, two-, and five-year survival rates compared to their Medicare-insured counterparts — who were also older (66-69) and more likely to have comorbidities. The reasons for these discrepancies are varied but certainly include lack of access to care. Patients who are uninsured are less likely to have a usual source of primary care and to participate in cancer screening programs leading them to present with later-stage disease that is not easily curable. Of note, patients in the younger age group who had insurance coverage had better survival rates than their older counterparts, as would be expected due to age differences.
Disparities in cancer outcomes also vary by race, with Black patients faring worse than white patients. When adjusting for insurance coverage these disparities decrease, although they are not eliminated.
The authors posit that lowering the Medicare eligibility age to 60 could improve cancer outcomes and reduce disparities. Why stop at 60? Patients across their lifespan are at risk of developing not just cancer, but other conditions that respond to early treatment and intervention. Nearly 20% of adults in the 45-64 age group have diabetes. Furthemore, nearly one in five deaths among adults 25-64 is due to cardiovascular disease.
We know that insurance coverage both improves survival and reduces racial disparities in outcomes, not only for cancer but also for other medical conditions – chronic and acute. It’s time to assure that all Americans have high-quality insurance. The only way to achieve this is thorough Medicare for All.
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