Medicaid enrollment at late stages may partly explain poor outcomes for cancer

A new study concludes that the unavailability of health insurance prior to Medicaid enrollment may contribute to poor outcomes in the Medicaid-insured cancer population.

The study, published in the April 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, says the poorest outcomes are among cancer patients who enroll in Medicaid after diagnosis. These individuals were likely uninsured prior to diagnosis and as such had been on the margins of the health care system for some time. Medicaid requires that individuals have both a disabling condition and low income and assets. Therefore, many of those enrolling in Medicaid after diagnosis have late stage cancers. The authors say their findings have far reaching implications for Medicaid's enrollment policies.

Recent studies demonstrate that access to healthcare alone does not improve survival rates for many cancers. A recent study showed, for instance, that Medicaid-supported breast cancer patients have similarly poor outcomes to uninsured patients. However, there is little research to explain the surprising lack of survival differences between Medicaid and uninsured patients. To further examine the contribution of Medicaid's policies in cancer outcome, Cathy Bradley, Ph.D. of Michigan State University and her colleagues reviewed the records of 13,740 subjects from the Michigan Tumor Registry.

According to analysis of the data, patients enrolled in Medicaid after diagnosis ("late enrolled") had a significantly poorer survival rate compared to patients diagnosed while enrolled in Medicaid and non-Medicaid patients. The median survival was 18 months for those diagnosed before enrollment compared to 38 months for those diagnosed after enrollment. Only 27 percent of these late enrollers had early stage cancers compared to 54 percent and 40 percent in the non-Medicaid insured and the patients already enrolled in Medicaid, respectively.

Dr. Bradley and her colleagues conclude, "From a policy perspective, cancer survival in the Medicaid population cannot be improved as long as 40 percent of the population enrolls in Medicaid after diagnosis with late stage disease. Care provided to these individuals may be futile."


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