News & Commentary

Cancer Patients Better Able To Access Care Under ACA

Cancer survivors were better able to afford care and did not see delays in treatment from 2010 through 2016, the years when the ACA was phased in, according to a study published in JAMA Oncology. But researchers were unable to definitively connect that trend to the ACA.

Health care access and affordability for cancer survivors

Source: Nipp RD, JAMA Oncology, March 29, 2018

That’s because though the ACA was enacted in 2010, many of the changes that made getting care more affordable did not come about until January 2014, according to Ryan D. Nipp, MD, and his colleagues at Massachusetts General Hospital and Harvard Medical School. The study was published online March 29.

“This fact, in addition to our lack of data prior to 2010, limit our ability to definitively state that the ACA alone caused the decreasing trends in health care access and affordability issues,” the study states. However, the authors noted that survivors’ access to medications improved in “the context of increasing drug prices for cancer and many other indications.”

Using data from the National Health Interview Survey, the study compared health care access between 15,182 cancer survivors and a like number of Americans with no reported history of cancer. The average age of participants was 63.5 years. The participants in the study group and the control group were matched in age within one year.

Survivors were more likely to be insured (94.8% vs. 92.2%) or to have government-sponsored insurance (44.3% vs. 38.8%) than the control group.

The researchers looked at four barriers to access and affordability: delays in getting medical care, inability to afford prescription medications, not being able to get needed medical care, and an inability to afford at least one of six different sorts of medical services (medications, follow-up care, specialist care, mental health care, dental care, or eyeglasses).

In all four areas, the situation improved for cancer survivors during the six years the study covered, although the trend reversed in 2016. So, for example, the proportion of cancer survivors reporting delayed medical care decreased by 0.47 percentage points per year, and the proportion of those needing and not getting medical care also decreased, although by a little less (0.35 percentage points each year).

Despite these improvements, the cancer survivors reported that they had more difficulties in the four areas of accessibility and affordability included in the study than people without cancer; for example, cancer survivors were 76% more likely to report having forgone medical care than the “control respondents.”

Previous research had shown that such financial barriers loom large for cancer survivors and have an effect on getting care. However, those studies were conducted prior to the ACA.

“Importantly, our results suggest that problems with health care access and affordability may have been ameliorated during our observation period,” wrote Nipp and the research team. “This is a critical finding, considering that the survey data tracked information during the years surrounding implementation of the ACA.”


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