Monday, November 9, 2015

qotd: Cancer care access and outcomes worse for Medi-Cal patients

UC Davis Health System
November 5, 2015
Statewide cancer report finds significant disparities in outcomes,
quality of care by insurer

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.

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.

Full IPHI report:


Comment by Don McCanne

Medi-Cal is a chronically underfunded Medicaid health program for
low-income individuals in California. As such, these patients do not
receive as much support from the health care community as do otherwise
insured patients. This study confirms that cancer patients in the
Medi-Cal and in the Medicare/MediCal dual eligible programs have
impaired access and impaired outcomes almost comparable to those of
uninsured patients.

Of note is that Medicare patients with added Medi-Cal coverage fared
worse than did Medicare patients without Medi-Cal coverage. It may be
that their lower incomes were associated with other socio-economic
problems that result in worse outcomes. It may also be that California
has been moving dual eligible patients into Medicaid managed care
programs when there is question about how effective these programs are
in delivering essential services. Another possibility is that physicians
may be rejecting these patients simply because of the welfare stigma of
the Medi-Cal program, even though they are on Medicare.

The conservatives have been preaching that Medicaid is as bad as having
no insurance at all, and may be even worse. Although their position has
been largely refuted, they will surely add this study to their "proof"
of this hypothesis. Governors in states that refused to expand their
Medicaid programs will find solace in this report.

The solution is obvious. Improve Medicare so that it is a more
comprehensive program, and then provide it to everyone. Although other
socio-economic factors need to be addressed, at least we would be
removing the Medicaid welfare stigma that includes chronic underfunding
by our elected representatives.

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