Cancer patients insured by California's Medicaid program are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a study by University of California-Davis researchers. Understanding how well Medicaid serves cancer patients is crucial, experts say, because as much as 10% of California's Medicaid expenditures go to cancer care. The researchers used California Cancer Registry data to study the experiences of approximately 700,000 Californians diagnosed with breast, colon, rectal, lung and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The findings include:
- Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage;
- Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance;
- Low-income seniors covered by Medicare and Medi-Cal, known as "dual-eligible patients," were the least likely to receive recommended treatment for breast and colon cancer; and
- VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.
What researchers don't know is the reason for these disparities. It's possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. Audits and studies also have shown that some of the state's Medi-Cal patients have difficulty getting access to doctors and specialists. Researchers also can't explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. They also don't know whether cancer patients fare better or worse in Medi-Cal managed care programs.