Cancer care of American Indians and Alaska Natives and Other Racial Groups Enrolled in Public and Private Insurance Plans
In: Poverty & Public Policy, Band 2, Heft 1
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In: Poverty & Public Policy, Band 2, Heft 1
In: Poverty & Public Policy, Band 2, Heft 1
In: Poverty & public policy: a global journal of social security, income, aid, and welfare, Band 2, Heft 1, S. 17-35
ISSN: 1944-2858
AbstractObjectives. To compare cancer care among American Indian and Alaska Native (AIAN) patients with other racial groups. Methods. We used Washington State cancer registry records to identify 33,624 patients < age 65 diagnosed with local and regional stage breast, colorectal, and lung cancer from 1997 to 2003. Records were linked with regional tribal registry and Medicaid records to identify AIAN. Results. Enrollment in Medicaid at or after diagnosis was 50% for AIAN, 34% for Hispanic, 33% for black, and 18% for Asian/Pacific Islander compared to 13% of white cancer patients. AIAN were equally as likely as whites and other minority groups to receive surgery for breast and colorectal cancer, but significantly less likely (OR = 0.67) to receive surgery for lung cancer. Medicaid patients in general were less likely to receive surgery within 2 months of diagnosis, but AIAN were no less likely to receive timely surgery compared to other racial groups. Conclusion. AIAN rely more heavily than other racial groups on Medicaid for insurance after they are diagnosed with cancer. Issues associated with Medicaid enrollment, as well as non‐insurance related factors may account for delays in time to surgery and lower rates of lung cancer surgery among AIAN.
Much has been written about the relationship between a person's high medical expenses and his or her likelihood of filing for bankruptcy, but the relationship between receiving a cancer diagnosis and filing for bankruptcy is less well understood. We estimated the incidence and relative risk of bankruptcy for people age twenty-one or older diagnosed with cancer compared to people the same age without cancer by conducting a retrospective cohort analysis that used a variety of medical, personal, legal, and bankruptcy sources covering the Western District of Washington State in US Bankruptcy Court for the period 1995–2009. We found that cancer patients were 2.65 times more likely to go bankrupt than people without cancer. Younger cancer patients had 2–5 times higher rates of bankruptcy compared to cancer patients age sixty-five or older, indicating that Medicare insurance and Social Security may mitigate bankruptcy risk for the older group. The findings suggest that employers and governments may have a policy role to play in creating programs and incentives that could help people cover expenses in the first year following a cancer diagnosis.
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