Q&A: Evaluating the Benefits of Health Insurance on Cancer Care
Patients with one of the four leading causes of cancer deaths have lower rates of cancer-specific survival based on where they live, specifically based on their social determinants of health.Sandra Wong, MD
Millions of Americans acquire their health insurance under the Affordable Care Act, including individuals from what census measures consider disadvantaged communities. The extent to which health insurance can ease the effects of the social determinants of health on cancer care is the subject of current research led by Norris Cotton Cancer Center’s Sandra Wong, MD, Professor and Chair of Surgery, Senior Vice President of the Surgical Services Line and Interim Vice President of the Oncology Service Line. Her work, “The impact of health insurance status on cancer care in disadvantaged communities” was recently published in the journal, Cancer. We followed up with her to learn more about her research and how it relates to our communities.
Q: In this publication of your study, what is the central problem that you are trying to solve?
Wong: We were seeking to examine the differential impact of health insurance on cancer care across communities with varying social determinants of health, which are defined by a summary measure comprised of U.S. Census measures of income, education, and employment.
Q: What did the study find?
Wong: Patients with one of the four leading causes of cancer deaths have lower rates of cancer-specific survival based on where they live, specifically based on their social determinants of health (their community’s relative “disadvantage,” as defined by a summary measure comprised of U.S. Census measures of income, education, and employment). The effect of having health insurance appears to be more pronounced in those from disadvantaged communities, compared to more advantaged communities, through better access to cancer care. However, the differences attributed to social determinants of health were not fully mitigated. Interestingly, Medicaid insurance was associated with a much more modest survival benefit in those from disadvantaged communities.
Q: What makes this research particularly important?
Wong: To the best of our knowledge, this is the first national study to explore the interplay between health insurance and social determinants of health and the resultant impact on cancer care and cancer outcomes.
Q: How will this study lead to improved cancer treatment or understanding of cancer mechanisms?
A: These data will help inform ongoing healthcare payment reform efforts. Those from the most disadvantaged communities benefit the most from health insurance, but there are still disparities compared the most advantaged communities. Provisions for insurance are necessary but insufficient to eliminate inequities in cancer outcomes.
Q: What are your next steps?
A: Attention is needed for community-level efforts and closer examination of the social determinants of health.
To learn more about Dr. Wong’s study, please visit http://onlinelibrary.wiley.com/doi/10.1002/cncr.30431/full