Ward Elizabeth, Halpern Michael, Schrag Nicole, Cokkinides Vilma, DeSantis Carol, Bandi Priti, Siegel Rebecca, Stewart Andrew, Jemal Ahmedin
Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA, USA.
CA Cancer J Clin. 2008 Jan-Feb;58(1):9-31. doi: 10.3322/CA.2007.0011. Epub 2007 Dec 20.
Advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14% decrease in the death rates from all cancers combined from 1991 to 2004 in the overall US population, with remarkable declines in mortality for the top 3 causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in women (breast and colorectal cancer). However, not all segments of the population have benefited equally from this progress, and evidence suggests that some of these differences are related to lack of access to health care. Lack of adequate health insurance appears to be a critical barrier to receipt of appropriate health care services. This article provides an overview of systems of health insurance in the United States, demographic and socioeconomic characteristics associated with health insurance coverage, and economic burdens related to health care among individuals and families. This article also presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey and the National Cancer Data Base. Although this article focuses on associations between health insurance and cancer care utilization and outcomes, it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient-level, provider, and health system factors. Evidence presented in this paper suggests that addressing insurance and cost-related barriers to care is a critical component of efforts to ensure that all Americans are able to share in the progress that can be achieved by access to high-quality cancer prevention, early detection, and treatment services.
1991年至2004年期间，美国总体人口中，癌症预防、早期检测及治疗方面的进展使所有癌症合并死亡率下降了近14%，男性癌症死亡的三大主要原因（肺癌、结直肠癌和前列腺癌）以及女性癌症死亡的三大主要原因中的两项（乳腺癌和结直肠癌）的死亡率显著下降。然而，并非所有人群都能平等地从这一进展中受益，有证据表明，其中一些差异与无法获得医疗保健服务有关。缺乏足够的医疗保险似乎是获得适当医疗保健服务的关键障碍。本文概述了美国的医疗保险体系、与医疗保险覆盖相关的人口统计学和社会经济特征，以及个人和家庭在医疗保健方面的经济负担。本文还基于对《国家健康访谈调查》和《国家癌症数据库》的分析，介绍了医疗保险状况与乳腺癌和结直肠癌筛查、诊断阶段及生存率之间关联的数据。尽管本文重点关注医疗保险与癌症医疗利用及结果之间的关联，但必须认识到，获得最佳癌症医疗的障碍是复杂的，涉及患者层面、医疗服务提供者和医疗系统等多方面因素。本文提供的证据表明，消除与保险和费用相关的医疗障碍是确保所有美国人都能分享通过获得高质量癌症预防、早期检测和治疗服务所能取得进展的努力的关键组成部分。
