Uninsured cancer patients receive only half the health services of insured cancer patients, yet pay much more out of pocket for that care, according to the study, which appears in this month's issue of Health Affairs.
Health policy researchers Kenneth E. Thorpe and David Howard tracked 1,383 cancer patients over a six-month period. Overall, those with private insurance averaged $6,550 worth of health-care services; while those without insurance got $3,606 worth of services.
Yet, insured patients paid $480 out of pocket; uninsured paid $1051.
"I think the study highlights that we need to refocus our attention on looking at patients who do not have health insurance," says Thorpe, head of the department of health policy and management at the Rollins School of Public Health at Emory.
"There are pockets of very, very sick people who, in the absence of health insurance, are really not getting the same access to health care as those with insurance would be getting," he adds.
The researchers extracted data for the years 1996 to 1999 from the Medical Expenditure Panel Survey, which is a nationally representative sample often used by researchers to track insurance status and health-care spending.
When they zeroed in on cancer patients under 65, the differences were also great. Insured patients got $8,419 in health services, while those without insurance got $4,806. Insured patients under 65 paid $549 of that out of pocket, while the uninsured paid $1,343 out of pocket -- almost 2.5 times as much.
Ethnic differences emerged, too. While 10 percent of cancer patients under age 65 are uninsured, Thorpe says, they found 20 percent of Hispanic cancer patients under 65 are without coverage.
As to why the uninsured got less care, Thorpe can only speculate. "These are people who probably don't have sustained attachments to the health-care system. They may not have a primary care doctor or get regular, routine care," he says.
Thorpe says there is little research on younger cancer patients and insurance status and health care spending. Most studies on insurance and health-care spending focus on Medicare patients.
The study results ring true for Ninez Ponce, an assistant professor of health policy at UCLA's School of Public Health who has studied cancer screening habits and the effects of insurance.
"It's not surprising that the uninsured are less likely to get care," she says. What's not clear, she adds, is whether it occurs because people don't seek out health care as much if they don't have insurance or whether doctors may treat them differently.
Intuitively, she says, "you would think the results are true. But to see it played out [in the study] reinforces the idea that not only programs to expand access to cancer screening but also programs to expand access to treatment are crucially important."
In her research, Ponce adds, she has found ethnic differences in how populations get screened for cancer, as well. "I find Latinos, Asians, Hawaiians, and other Pacific Islanders have low screening rates."