POLICY/QUALITY: Uninsurance does indeed kill you quicker

I'm not going to go into the whys and wherefores of what's wrong with cancer care in this country. But when the IOM said that people die early because of uninsurance, people scoffed. The same people (and you know who you are David Gratzer) say (pretty disingenuously) that we do cancer care much better than countries with universal insurance, and for at least partly that reason universal insurance is a bad idea.

So presumably they have a good answer for this new report from the American Cancer Society, which essentially shows that--whatever the state of American cancer care maybe overall--you're much more more likely to have a good outcome if you've got insurance. Some tidbits from the release:

For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance.The relationship between access to care and cancer outcomes is particularly striking for several cancers which can be prevented or detected earlier by screening and for which there are effective treatments, including breast and colorectal cancer. At every level of education, individuals with health insurance were about twice as likely as those without health insurance to have had mammography or colorectal cancer screening.

    For breast cancer, the article reports that:

• Women without health insurance are about half as likely as those with private health insurance to have received a mammogram in the past two years (38.1 percent of uninsured women versus 74.5 percent of insured women age 40-64), a pattern seen for all race/ethnicities studied (white, African American and Hispanic) at all levels of education.   
• Twenty to 30 percent of uninsured women were diagnosed with late stage (stage III/IV) breast cancer, compared with ten to 15 percent of privately insured patients.
• Uninsured women were also less likely to be diagnosed with Stage I (early) breast cancer than privately insured women. In white women, where this disparity was greatest, almost 50 percent of those who were privately insured were diagnosed with early-stage cancer, compared to less than 35 percent of those who were uninsured.
• Among white women diagnosed with all stages of breast cancer, 76 percent of those who were uninsured survived five years, compared with 89 percent of those with private insurance; among African Americans, five-year survival rates were 65 percent for uninsured and 81 percent for privately insured women; among Hispanics, five-year survival rates were 83 percent for uninsured and 86 percent for privately insured women.;
• Differences in survival between privately insured and uninsured women were seen for all stages of breast cancer.   

For colorectal cancer, the report found that:

• Among men and women aged 50 to 64 years with private insurance, nearly half (48.3 percent) had had a recommended colorectal cancer screening test in the past ten years compared with fewer than one in five (18.8 percent) of those who were uninsured.
• Patients without health insurance were more likely than those with private insurance to be diagnosed with Stage IV and less likely to be diagnosed with Stage I colorectal cancer
• Among whites, 50 percent of uninsured patients survived colorectal cancer for five years, compared to 66 percent who had private insurance; among African Americans, five-year survival rates were 41 percent among the uninsured compared with 60 percent of privately insured patients; among Hispanics, 57 percent of patients with no insurance survived five years compared with 63 percent of privately insured patients.
• Differences in survival between privately insured and uninsured patients were seen for all stages of colorectal cancer.   
• Privately insured patients diagnosed with Stage II colorectal cancer were more likely to survive 5 years than uninsured patients diagnosed with Stage I

Other findings from the study:

• Women between 40 and 64 without insurance were less likely than women with private insurance to have had a Pap test in the past three years (68 percent versus 87.9 percent). 
• More than one in three privately insured men (37.1 percent) aged 50 to 64 years had received a prostate specific antigen test versus just one in seven (14 percent) uninsured men.
• Among individuals under age 65 years, those aged 18 to 24 years have the highest probability of being uninsured.
• The probability of being uninsured varies inversely by income.
• African Americans, Hispanics, Asian American/Pacific Islanders, and American Indian/Alaska Natives are much more likely to be uninsured than non-Hispanic Whites
• More than half (53.6 percent) of uninsured individuals aged 18 to 64 years have no usual source of health care
• The uninsured are more likely to report that cost issues caused them to delay care, not receive care, and not obtain prescription drugs
• Among those who saw a health care practitioner, the uninsured were less likely to be advised to quit smoking or to lose weight

Oh, and one more little thing. Being uninsured and having cancer usually means a financial meltdown, too. Example A is the first chapter in Sick.