Virgo Katherine S, Lin Chun Chieh, Davidoff Amy, Guy Gery P, de Moor Janet S, Ekwueme Donatus U, Kent Erin E, Chawla Neetu, Yabroff K Robin
Res Sociol Health Care. 2018 Sep;36:59-84. doi: 10.1108/S0275-495920180000036003.
PURPOSE –: To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and access to care.
METHODOLOGY –: Longitudinal 2008-2013 Medical Expenditure Panel Survey data pooled yielding 2,223 cancer survivors and 50,692 individuals with no cancer history ages 18-63 years upon survey entry, with gender-specific sub-analyses. Access-to-care implications of insurance loss or gain were compared by cancer history and gender.
FINDINGS –: Initially uninsured cancer survivors were significantly more likely to gain insurance coverage than individuals with no cancer history (RR: 1.25; 95% CI: 1.08-1.44). Females in particular were significantly more likely to gain insurance (unmarried RR: 1.16; 95% CI: 1.06-1.28; married RR: 1.09; 95% CI: 1.02-1.16). Significantly higher rates of difficulty accessing needed medical care and prescription medications were reported by those remaining uninsured, those who lost insurance, and women in general. Remaining uninsured, losing insurance, and male gender were associated with lack of a usual source of care.
RESEARCH IMPLICATIONS –: Additional outreach to disadvantaged populations is needed to improve access to affordable insurance and medical care. Future longitudinal studies should assess whether major Affordable Care Act (ACA) provisions enacted after the 2008-2013 study period (or those of ACA's replacement) are addressing these important issues.
ORIGINALITY –: Loss of health insurance coverage can reduce health care access resulting in poor health outcomes. Cancer survivors may be particularly at risk of insurance coverage gaps due to the long-term chronic disease trajectory. This study is novel in exploring associations between cancer history by gender and health insurance transitions, both gains and losses, in a national non-elderly adult sample.
研究癌症病史与主要医疗保险转变（增减）之间的性别关联，以及保险转变与医疗服务可及性之间的关系。
汇总2008 - 2013年纵向医疗支出面板调查数据，得到2223名癌症幸存者和50692名在调查开始时年龄为18 - 63岁且无癌症病史的个体，并进行性别特异性亚分析。按癌症病史和性别比较保险损失或增加对医疗服务可及性的影响。
最初未参保的癌症幸存者获得保险覆盖的可能性显著高于无癌症病史的个体（风险比：1.25；95%置信区间：1.08 - 1.44）。尤其是女性获得保险的可能性显著更高（未婚女性风险比：1.16；95%置信区间：1.06 - 1.28；已婚女性风险比：1.09；95%置信区间：1.02 - 1.16）。报告称，仍未参保者、失去保险者以及总体女性在获取所需医疗服务和处方药方面遇到困难的比例显著更高。仍未参保、失去保险以及男性与缺乏常规医疗服务来源有关。
需要向弱势群体进行更多宣传推广，以改善其获得可负担保险和医疗服务的机会。未来的纵向研究应评估在2008 - 2013年研究期之后颁布的《平价医疗法案》（ACA）主要条款（或其替代法案的条款）是否正在解决这些重要问题。
医疗保险覆盖范围的丧失会降低医疗服务可及性，从而导致不良健康结果。由于长期慢性病病程，癌症幸存者可能尤其面临保险覆盖缺口的风险。本研究在全国非老年成人样本中探索癌症病史按性别与医疗保险转变（包括增加和减少）之间的关联，具有创新性。
