Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform

Abstract Background Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all women with hormone receptor-positive non-metastatic BCA. However, AET use among uninsured or underinsured populations has been understudied. The health reform implemented by the US state of Massachusetts in 2006 expanded health insurance coverage and increased the scope of benefits for many with coverage. This study examines changes in the initiation of AET among BCA patients in Massachusetts after the health reform. Methods We used Massachusetts Cancer Registry data from 2004 to 2013 for a sample of estrogen receptor (ER)-positive BCA surgical patients aged 20–64 years. We estimated multivariable regression models to assess differential changes in the likelihood initiating AET after Massachusetts health reform by area-level income, comparing women from lower- and higher-income ZIP codes in Massachusetts. Results There was a 5-percentage point (p-value< 0.001) relative increase in the likelihood of initiating AET among BCA patients aged 20–64 years in low-income areas, compared to higher-income areas, after the reform. The increase was more pronounced among younger patients aged 20–49 years (7.1-percentage point increase). Conclusions The expansion of health insurance in Massachusetts was associated with a significant relative increase in the likelihood of AET initiation among women in low-income areas compared with those in high-income areas. Our results suggest that expansions of health insurance coverage and improved access to care can increase the number of eligible patients initiating AET and may ameliorate socioeconomic disparities in BCA outcomes.

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How government health insurance coverage of novel anti-cancer medicines benefited patients in China – a retrospective analysis of hospital clinical data

BMC Health Services Research ◽

10.1186/s12913-021-06840-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yifan Diao ◽

Mengbo Lin ◽

Kai Xu ◽

Ji Huang ◽

Xiongwei Wu ◽

...

Keyword(s):

Breast Cancer ◽

Health Insurance ◽

Regression Model ◽

Low Income ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Government Health ◽

Anti Cancer ◽

The Government ◽

Medication Choice

Abstract Background China started to cover novel medicines for the treatment of major cancers, such as trastuzumab for breast cancer by the government health insurance programs since 2016. Limited data have been published on the use of cancer medications and little is known about how government health insurance coverage of novel anti-cancer medicines benefited patients in the real world. This study aimed to generate evidence to inform the health security authorities to optimize the government health insurance coverage of novel anti-cancer medicines as a more inclusive and equal policy, through which each of the needed patient can get access to the novel anti-cancer medicines regardless of the ability to pay. Methods The study targeted one of the government health insurance newly covered novel medicines for breast cancer and the breast cancer patients. The analyses were based on the data collected from one tertiary public hospital in Fujian province of China. We conducted interrupted time series analysis with a segmented regression model and multivariate analyses with a binary logistic regression model to analyze the impact of the government health insurance coverage on medicines utilization and the determinants of patient’s medication choice. Results The average proportion of patients who initiated medication with novel medicines increased from 37.4% before the government health insurance coverage to 69.2% afterwards. Such an increase was observed in all patient sub-groups. The monthly proportion of patients who initiated medication with novel medicines increased sharply by 18.3 % (95 %CI,10.4-34.0 %, p = 0.01) in September 2017, the afterwards trend continuously increased (95 %CI,1.03–3.60, p = 0.02). The critical determinants of patient's medication choice were mostly connected with the patient's health insurance benefits packages. Conclusions The government health insurance coverage of novel anti-breast-cancer medicines benefited the patients generally. The utilization of novel medicines such as trastuzumab continuously increased. The insurance coverage benefited well the patients in the high-risk age groups. However, rural patients, patients enrolled in the “resident program”, and patients from low-income residential areas and non-local patients benefited less from this policy. Improving the benefits package of the low-income patients and the “resident program” beneficiary would be of considerable significance for a more inclusive and equal health insurance coverage of novel anti-cancer medicines.

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The convergence of racial and income disparities in health insurance coverage in the United States

International Journal for Equity in Health ◽

10.1186/s12939-021-01436-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

De-Chih Lee ◽

Hailun Liang ◽

Leiyu Shi

Keyword(s):

Health Insurance ◽

Low Income ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

The United States ◽

Combined Effect ◽

Medical Expenditure ◽

The Us ◽

Race Ethnicity ◽

Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

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Health Insurance Coverage and Use of Services Among Low-Income Elders:Does Residence Influence the Relationship?

The Journal of Rural Health ◽

10.1111/j.1748-0361.1995.tb00401.x ◽

1995 ◽

Vol 11 (2) ◽

pp. 86-97 ◽

Cited By ~ 10

Author(s):

Karen Seccombe

Keyword(s):

Health Insurance ◽

Low Income ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Use Of Services ◽

The Relationship

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Health Reform and Changes in Health Insurance Coverage in 2014

New England Journal of Medicine ◽

10.1056/nejmsr1406753 ◽

2014 ◽

Vol 371 (9) ◽

pp. 867-874 ◽

Cited By ~ 100

Author(s):

Benjamin D. Sommers ◽

Thomas Musco ◽

Kenneth Finegold ◽

Munira Z. Gunja ◽

Amy Burke ◽

...

Keyword(s):

Health Insurance ◽

Health Reform ◽

Insurance Coverage ◽

Health Insurance Coverage

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France

10.1093/oso/9780198860525.003.0025 ◽

2021 ◽

pp. 558-589

Author(s):

Matthias Brunn ◽

Patrick Hassenteufel

Keyword(s):

Health Insurance ◽

Low Income ◽

Public Management ◽

New Public Management ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

National Health Insurance System ◽

Health Politics ◽

New Public ◽

Unusual Combination

This chapter offers an in-depth look at health politics and the national health insurance system in France. It traces the development of the French healthcare system through its series of political regimes, characterized by its unusual combination of statism and corporatism. Since the 1990s, a technocratic consensus emerged that has led to new public management reforms, tighter parliamentary control of social security budgets, and efforts to improve coverage by subsidizing supplementary voluntary health insurance coverage for low-income persons and increasing tax-financing. Other healthcare issues have been regional health inequalities, reimbursement of medical professionals, and individuals’ responsibility for their health.

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