01:28am Monday 18 December 2017

Statewide cancer report finds significant disparities in outcomes, quality of care by insurer

(SACRAMENTO, Calif.)— A new report by the UC Davis Institute for Population Health Improvement (IPHI) comparing quality of care and outcomes for breast, colon, rectal, lung and prostate cancers according to source of health insurance coverage has identified substantial disparities in stage of diagnosis, providers’ use of recommended treatment and survival rates.

Medi-Cal, Medicare/Medi-Cal dual eligible patients and those without insurance were diagnosed at more advanced stages of disease, received lower quality of care and had poorer outcomes than those with private, other health insurance, a UC Davis IPHI statewide report has found. Medi-Cal, Medicare/Medi-Cal dual eligible patients and those without insurance were diagnosed at more advanced stages of disease, received lower quality of care and had poorer outcomes than those with private, other health insurance, a UC Davis IPHI statewide report has found.

The report, “Disparities in Stage-at-Diagnosis, Survival and Quality of Cancer Care in California by Source of Health Insurance,” posted online today on IPHI’s California Cancer Reporting and Epidemiologic Surveillance (CalCARES) program website.

The report reviewed data for nearly 700,000 Californians from the California Cancer Registry during the nine-year period 2004 through 2012. The analysis is believed to be the first population-based overview of quality of cancer care and outcomes that includes all major categories of health insurance: private insurers, Medicare, Medi-Cal, uninsured, Medicare/Medi-Cal dual eligibility, Veterans Affairs (VA) and Department of Defense (DoD).

According to Kenneth W. Kizer, IPHI and CalCARES director, while cancer treatment has generally improved in recent years, disparities in quality of cancer treatment and survival rates by health insurance remain a significant population health problem. 

“Our study found that there are substantial opportunities for improved cancer care among all categories of payers, although the greatest opportunities for improvement exist for patients with Medi-Cal coverage, Medicare/Medi-Cal dual eligibility or no health insurance,” Kizer said. “These patients were diagnosed at more advanced stages of disease, received lower quality of care and had poorer outcomes than persons having private insurance or insurance coverage through Medicare, VA or DoD.

“Given that Medi-Cal is now the largest insurance program in California, with enrollment increasing from 7 to over 12 million members over the past three years and the estimated cost of cancer care for Medi-Cal growing from $3 billion to well over $6 billion, we need to better understand why Medi-Cal patients are not faring better,” he said.

Other key report findings:

  • Significantly larger proportions of Medi-Cal and uninsured patients were diagnosed at an advanced stage of disease compared to patients with other sources of health insurance.
  • Medi-Cal and uninsured patients had generally less favorable five-year survival rates.
  • Medicare/Medi-Cal dual eligible patients were least likely to receive recommended treatment for breast cancer and colon cancer.
  • VA patients had the longest intervals between diagnosis and initiation of treatment, but they were generally more likely to receive recommended treatment, and their treatment outcomes compared favorably to patients with other types of health insurance.  
  • Medi-Cal patients were diagnosed with advanced (stage 4) prostate cancer more than three times as often as patients with private insurance

For the study, CalCARES assessed stage at diagnosis, quality of treatment as measured by standard quality performance measures and five-year survival rates among persons diagnosed with breast, colon, rectal, lung and prostate cancer. The analysis used only the payer source information available in the cancer registry, which may underestimate Medi-Cal coverage. If the registry more completely captured this data the results might show greater disparities for Medi-Cal members. 

The report strongly recommends that further investigation be done linking cancer registry data with Medi-Cal enrollment and paid claims data to better understand the reasons behind the observed disparities.

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The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by the California Health Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER) program under contacts awarded to the Cancer Prevention Institute of California, the University of Southern California, and the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement awarded to the California Department of Public Health.

About IPHI

The Institute for Population Health Improvement works to create, apply and disseminate knowledge about the many determinants of health in order to improve health and health security and to support activities which improve health equity and eliminate health disparities.


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