Research article summary (published 29 Jun 2009):

Inadequate access to surgeons: reason for disparate cancer care?

Full Abstract

OBJECTIVE: To compare the likelihood of seeing a surgeon between elderly dually eligible non-small-cell lung cancer (NSCLC) and colon cancer patients and their Medicare counterparts. Surgery rates between dually eligible and Medicare patients who were evaluated by a surgeon were also assessed. METHODS: We used statewide Medicaid and Medicare data merged with the Michigan Tumor Registry to extract a sample of patients with a first primary NSCLC (n = 1100) or colon cancer (n = 2086). The study period was from January 1, 1997 to December 31, 2000. We assessed the likelihood of a surgical evaluation using logistic models that included patient characteristics, tumor stage, and census tracts. Among patients evaluated by a surgeon, we used logistic regression to predict if a resection was performed. RESULTS: Dually eligible patients were nearly half as likely to be evaluated by a surgeon as Medicare patients (odds ratio [OR] = 0.49; 95% confidence interval = 0.32, 0.77 and odds ratio = 0.59; 95% confidence interval = 0.41, 0.86 for NSCLC and colon cancer patients, respectively). Among patients who were evaluated by a surgeon, the likelihood of resection was not statistically significantly different between dually eligible and Medicare patients. CONCLUSIONS: This study suggests that dually eligible patients, in spite of having Medicaid insurance, are less likely to be evaluated by a surgeon relative to their Medicare counterparts. Policies and interventions aimed toward increasing access to specialists and complete diagnostic work-ups (eg, colonoscopy, bronchoscopy) are needed.

Author information

Author/s: Bradley, Cathy J (CJ); Dahman, Bassam (B); Given, Charles W (CW);

Affiliation: Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, 1008 Clay Street, Richmond, VA 23298-0203, USA. cjbradley(-atsign-)vcu.edu

Grants: R01-CA101835-01 (Agency:NCI NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Medical care (Med Care), published in United States. (Language: eng)

Reference: 2009-Jul; vol 47 (issue 7) : pp 758-64

Dates: Created 2009/06/25; Completed 2009/07/16;

PMID: 19536001, status: MEDLINE (last retrieval date: 7/25/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Aged, 80 and over Carcinoma, Non-Small-Cell Lung - epidemiology; pathology; surgery Colonic Neoplasms - epidemiology; pathology; surgery Female Health Services Accessibility - organization & administration Health Services Research Healthcare Disparities - organization & administration Humans Insurance Claim Reporting - statistics & numerical data Likelihood Functions

Logistic Models Lung Neoplasms - epidemiology; pathology; surgery Male Medicaid - organization & administration Medicare - organization & administration Michigan - epidemiology Patient Selection Private Sector Registries Reimbursement Mechanisms - organization & administration United States

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