Cousineau Michael R, Kim Sue E, Hamilton Ann S, Miller Kimberly A, Milam Joel
1 Keck School of Medicine of USC, Los Angeles, USA.
Inquiry. 2019 Jan-Dec;56:46958018817996. doi: 10.1177/0046958018817996.
The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents' regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancer specialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen a primary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). In addition, those with public (vs private) insurance were less likely to have a regular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likely to have made a primary care visit in the past year (OR = 2.8, 95% CI = 2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, and those with public (vs. private) insurance have less access to primary care. Policies that ensure continuity of coverage for survivors as they age into adulthood may result in fewer barriers to needed care, which may lead to fewer health problems for CCS in the future.
本研究的目的是评估医疗保险覆盖范围在儿童癌症幸存者（CCS）的医疗保健利用模式以及获得癌症相关后续治疗和非癌症治疗方面所起的作用。采用横断面调查设计。儿童癌症幸存者来自洛杉矶县的两家大型医院。通过洛杉矶癌症监测项目共识别出235名幸存者，他们于2000年至2007年期间在5至18岁被诊断患有除霍奇金淋巴瘤之外的任何癌症类型。在2009年至2010年数据收集时，参与者年龄在15至25岁之间。研究暴露因素为医疗保险覆盖范围（私人保险、公共保险和无保险）。主要结局和衡量指标为受访者进行癌症后续治疗、非癌症治疗以及两者的常规医疗服务来源；以及在过去两年内进行癌症后续就诊、初级保健就诊和医院急诊科就诊的情况。与拥有私人保险的人相比，无保险者进行癌症后续治疗的常规医疗服务来源可能性更小（优势比[OR]=4.3，95%置信区间[CI]=1.9 - 9.4），获得非癌症治疗医疗服务来源的可能性更小（OR = 3.3，95% CI 1.6 - 6.9），同时获得两者医疗服务来源的可能性更小（OR = 5.3，95% CI = 2.1 - 13.5）。此外，无保险的儿童癌症幸存者看癌症专科医生的可能性更小（OR = 4.5，95% CI = 2.1 - 9.50），且在过去两年内看初级保健医生的可能性更小（OR = 3.9，95% CI = 1.8 - 8.2）。另外，拥有公共保险（与私人保险相比）者获得初级保健常规医疗服务提供者的可能性更小（OR = 2.5，95% CI = 1.1 - 5.4），且在过去一年进行初级保健就诊的可能性更小（OR = 2.8，95% CI = 2.1 - 13.5）。无保险的儿童癌症幸存者有无法获得癌症后续治疗的风险，而拥有公共保险（与私人保险相比）者获得初级保健的机会更少。确保幸存者成年后保险覆盖连续性的政策可能会减少获得所需治疗的障碍，这可能会使儿童癌症幸存者未来的健康问题减少。
