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Health Affairs, 28, no. 1 (2009):
147
doi: 10.1377/hlthaff.28.1.147 © 2009 by Project HOPE |
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Cancer |
PROLOGUE
The Special Case Of Cancer
Cancer is the number-two killer of Americans, with roughly 560,000 projected to die this year from this family of diseases. But millions more are now living for many years with cancer, thanks to advances in screening, diagnosis, and treatment. For millions, then, cancer has become in effect a chronic disease—albeit one whose profile is decidedly different than for other chronic conditions like diabetes. But cancer care, like most health care delivered in the United States, is plagued with quality issues and subject to wide disparities.
Tackling the issue of quality, Lynn Etheredge explores the leadership role that Medicare might play in raising the bar in cancer treatment. By the close of 2008, Etheredge writes, roughly 750,000 new Medicare patients will be added to the five million beneficiaries already living with cancer. Thus, if Medicare used its purchasing power to refashion cancer care, major changes could result. He proposes that the Centers for Medicare and Medicaid Services (CMS) place more emphasis on effectiveness research of cancer treatments; reformulated quality measures clearly showing who provides the best cancer care; payment reforms incentivizing such excellent care; and new agency leadership explicitly committed to promoting best practices for treatment of Medicare cancer patients.
Next, Beth Virnig and colleagues illuminate the role that race can play in determining who gets diagnosed with cancer—and when. Analysis of the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) database shows that for the vast majority of cancers and solid tumor sites, whites are typically diagnosed at earlier stages than African Americans. Not surprisingly, whites are significantly more likely to survive five years for most cancers. The authors propose more research to identify the causes and suggest that insurance coverage alone is unlikely to narrow the gaps.
Karen Emmons and coauthors reach a different conclusion in their analysis of colorectal cancer screening in a sample of low-income minority patients. They draw on a baseline survey from a randomized study of a colon cancer prevention initiative delivered through low-income housing sites. Roughly three-quarters of those who participated were covered by some form of public health insurance; about two-thirds self-reported that they had been screened. Emmons and colleagues conclude that insurance coverage does indeed matter. In an era when state and national health care reform strategies are likely to incorporate more emphasis on prevention, screening, and wellness, broadening insurance coverage may help reduce racial and ethnic disparities in cancer screening.
Related Articles
- Lynn M. Etheredge
Medicare’s Future: Cancer Care
Health Affairs, January/February 2009; 28(1): 148-159.
[Abstract] [Full Text] [PDF] [Erratum]
- Beth A. Virnig, Nancy N. Baxter, Elizabeth B. Habermann, Roger D. Feldman, and Cathy J. Bradley
A Matter Of Race: Early-Versus Late-Stage Cancer Diagnosis
Health Affairs, January/February 2009; 28(1): 160-168.
[Abstract] [Full Text] [PDF]
- Karen M. Emmons, Rebecca Lobb, Elaine Puleo, Gary Bennett, Elena Stoffel, and Sapna Syngal
Colorectal Cancer Screening: Prevalence Among Low-Income Groups With Health Insurance
Health Affairs, January/February 2009; 28(1): 169-177.
[Abstract] [Full Text] [PDF]
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