保险改革期间保险覆盖范围对癌症筛查异常诊断分辨率的影响。
The impact of insurance coverage during insurance reform on diagnostic resolution of cancer screening abnormalities.
作者信息
Kapoor Alok, Battaglia Tracy A, Isabelle Alexis P, Hanchate Amresh D, Kalish Richard L, Bak Sharon, Mishuris Rebecca G, Shroff Swati M, Freund Karen M
出版信息
J Health Care Poor Underserved. 2014 Feb;25(1 Suppl):109-21. doi: 10.1353/hpu.2014.0063.
We examined the impact of Massachusetts insurance reform on the care of women at six community health centers with abnormal breast and cervical cancer screening to investigate whether stability of insurance coverage was associated with more timely diagnostic resolution. We conducted Cox proportional hazards models to predict time from cancer screening to diagnostic resolution, examining the impact of 1) insurance status at time of screening abnormality, 2) number of insurance switches over a three-year period, and 3) insurance history over a three-year period. We identified 1,165 women with breast and 781 with cervical cancer screening abnormalities. In the breast cohort, Medicaid insurance at baseline, continuous public insurance, and losing insurance predicted delayed resolution. We did not find these effects in the cervical cohort. These data provide evidence that stability of health insurance coverage with insurance reform nationally may improve timely care after abnormal cancer screening in historically underserved women.
我们在六个社区健康中心，对患有异常乳腺癌和宫颈癌筛查的女性进行了马萨诸塞州保险改革对其医疗护理影响的研究，以调查保险覆盖的稳定性是否与更及时的诊断解决相关。我们进行了Cox比例风险模型，以预测从癌症筛查到诊断解决的时间，研究了以下因素的影响：1）筛查异常时的保险状况；2）三年期间保险转换的次数；3）三年期间的保险历史。我们确定了1165名有乳腺癌筛查异常的女性和781名有宫颈癌筛查异常的女性。在乳腺癌队列中，基线时的医疗补助保险、持续的公共保险以及失去保险都预示着诊断解决延迟。我们在宫颈癌队列中未发现这些影响。这些数据表明，全国性保险改革带来的医疗保险覆盖稳定性，可能会改善历史上服务不足的女性在癌症筛查异常后的及时护理。
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