评估癌症患者的医疗补助扩展福利：国家癌症数据库分析和系统评价。
Evaluating Medicaid expansion benefits for patients with cancer: National Cancer Database analysis and systematic review.
机构信息
Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90033, USA.
出版信息
J Cancer Policy. 2021 Sep;29:100292. doi: 10.1016/j.jcpo.2021.100292. Epub 2021 Jun 5.
BACKGROUND
Insurance status modifies healthcare access and inequities. The Affordable Care Act expanded Medicaid coverage for people with low incomes in the United States. This study assessed the consequences of this policy change for cancer care after expansion in 2014.
METHODS
National Cancer Database (NCDB) public benchmark reports were queried for each malignancy in 2013 and 2016. Furthermore, a systematic search [PubMed, Embase, Scopus and Cochrane] was performed. Data on insurance status, access to cancer screening and treatment, and socioeconomic disparities in these metrics was collected.
RESULTS
Two-tailed analysis of the NCDB revealed that 14 out of 18 eligible states had a statistically significant increase in Medicaid-insured patients with cancer after expansion. The average percentage increase was 51 % (13.2-204 %). From the systematic review, 229 studies were identified, 26 met inclusion. All 21 relevant articles reported lower uninsured rates. The average increase of Medicaid-insured patients was 77 % (9.5-230 %) and the average decrease of uninsured rates was 55 % (13.4-73 %). 15 out of 21 articles reported increased access to care. 16 out of 17 articles reported reductions in inequities.
CONCLUSION
Medicaid expansion in 2014 increased the number of insured patients with cancer. Expansion also improved access to screening and treatment in most oncologic care, and reduced socioeconomic disparities. Further studies evaluating correlative survival outcomes are needed.
POLICY SUMMARY
This study informs debates on expansion of Medicaid in state governments and electorates in the United States, and on health insurance reform broadly, by providing insight into how health insurance can benefit people with cancer while revealing how less insurance coverage could harm patients with cancer before and after their diagnosis. This study also contributes to discussions of health insurance mandates, subsidized coverage for people with low incomes, and covered healthcare services determinations by public and private health insurance providers in other countries.
背景
保险状况会影响医疗保健的可及性和公平性。平价医疗法案扩大了美国低收入人群的医疗补助覆盖范围。本研究评估了 2014 年该政策扩大后对癌症治疗的影响。
方法
查询了 2013 年和 2016 年国家癌症数据库（NCDB）公共基准报告中每种恶性肿瘤的数据。此外，还进行了系统搜索[PubMed、Embase、Scopus 和 Cochrane]。收集了保险状况、癌症筛查和治疗的可及性以及这些指标中的社会经济差异的数据。
结果
对 NCDB 的双侧分析显示，在扩大医疗补助覆盖范围后，18 个符合条件的州中有 14 个州的癌症患者中医疗保险参保人数有统计学意义的增加。平均增幅为 51%（13.2%-204%）。从系统评价中，确定了 229 项研究，其中 26 项符合纳入标准。所有 21 篇相关文章均报告了较低的未参保率。医疗保险参保人数的平均增幅为 77%（9.5%-230%），未参保率的平均降幅为 55%（13.4%-73%）。21 篇文章中有 15 篇报道称获得了更多的医疗服务。17 篇文章中有 16 篇报道称减少了不公平现象。
结论
2014 年医疗补助的扩大增加了癌症患者的参保人数。扩大医疗补助还改善了大多数肿瘤治疗中筛查和治疗的可及性，并减少了社会经济差异。需要进一步研究评估相关的生存结果。
政策总结
本研究通过提供有关医疗保险如何有益于癌症患者的信息，同时揭示医疗保险覆盖范围减少如何在癌症患者诊断前后对患者造成伤害，为州政府和美国选民关于医疗补助扩大的辩论以及更广泛的医疗保险改革提供了信息。本研究还为其他国家的公共和私人医疗保险提供商关于医疗保险强制规定、为低收入人群提供补贴性保险覆盖以及确定涵盖的医疗服务的讨论做出了贡献。
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