Access to Health Care:The Cancer Perspective

Daniel E. Smith

President,American Cancer Society Cancer Action Network (ACS

CAN)

November 2007

Making Progress

8090

100110120130140150160170180190200210220

'75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 '08 '10 '13

Year

Rate

Incidence and mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review 1975-2003.

All Sites – Mortality RatesAll Sites – Mortality Rates

By Year of Death – All Races, Males and Females

1991 Baseline 215.1 2004

185.7

2015 Goal – 50 Percent Reduction from Baseline

2015 Goal 107.6

( 13.7% from Baseline)

(Current trend to 2015 - 36.8% from Baseline) (The latest joinpoint trend (2002-2004) shows a -2.1 APC in age-adjusted rates)

2015 Projected Rate-135.9R

ate

Odds of More Advanced Stage at Diagnosis, Breast Cancer, NCDB, 1998-2004

Insurance Stage II vs. IStage III or IV

vs. I Private 1.0 (Ref.) 1.0 (Ref.)

Uninsured 1.5* 2.9*

Medicaid 1.5* 2.7*

Medicare Age 65+ 1.0 1.2*

Race Non-Hispanic White 1.0 (Ref.) 1.0 (Ref.)

Non-Hispanic Black 1.5* 1.9*

Hispanic 1.3* 1.3**Odds ratio is significant at the 95% confidence level.Note: Model adjusted for insurance type, race/ethnicity, age at diagnosis, income, proportion without high school degree, US census region, year of diagnosis, and facility type.Source: Halpern et al, 2007 (manuscript in preparation)

Odds of More Advanced Stage at Diagnosis, Colorectal Cancer, NCDB, 1998-2004

Insurance Stage II vs. IStage III or IV

vs. I Private 1.0 (Ref.) 1.0 (Ref.)

Uninsured 1.9* 2.0*

Medicaid 1.4* 1.6*

Medicare Age 65+ 1.0 1.0

Race Non-Hispanic White 1.0 (Ref.) 1.0 (Ref.)

Non-Hispanic Black 1.1* 1.3*

Hispanic 1.1* 1.1**Odds ratio is significant at the 95% confidence level.Note: Model adjusted for insurance type, race/ethnicity, age at diagnosis, income, proportion without high school degree, US census region, year of diagnosis, and facility type..Source: Halpern et al, 2007 (manuscript in preparation)

Cancer creates financial burdens

Percent who say each of the following happened to them/their family member as a result of the financial cost of dealing with cancer…

6%

7%

7%

9%

10%

22%

6%

15%

35%

41%

34%

30%

46%

3%

Ever uninsuredduring illness

Always insuredduring illness

Used up all or most of savings

Borrowed money from relatives

Contacted by a collection agency

Unable to pay for basic necessities like food, heat, or

housingSought the aid of charity or public

assistance

Borrowed money/got a loan/another mortgage

Declared bankruptcy

Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health Cancer Survey (conducted August 1 – September 14, 2006)

Most Important Diseases or Health Conditions the Government Should Address?

11%

16%

21%

41%

51%

Diabetes

Heart disease

Avian flu

HIV/AIDS

Cancer

Harvard School of Public Health and the Robert Wood Johnson Foundation, Americans’ Views of Public Health, April 2006.

Our Charge

American Cancer Society’s vision: – By 2015, everyone will have timely

access to the full range of evidence-based health care necessary to optimize health and well-being.

American Cancer Society’s role: – We will help frame the debate by

bringing national attention to access to care as seen through the cancer lens.

“What is Meaningful Insurance?” - Policy Review Group

• Phase 1 – Principles statement and evaluative tool (2006)

• Phase 2 – Incentives for prevention in the health systems (March 2007)

• Phase 3 –Costs (October 2007)

• Additional research underway

Develop Policy Options Looking at the Health Care System through the Cancer Lens

The Four A’s:

• Adequacy

• Affordability

• Availability

• Administrative Simplicity

Phase I: Principles Statement

How will we evaluate meaningful insurance?

Phase I:The Evaluative Tool

• A detailed list of questions the Society will ask about any reform proposal or health care system

• May be applied to different models of health care reform or change

• Provide the basis for developing practical and more specific evaluative criteria in the four main areas: adequacy, availability, affordability, and administrative simplicity

• Accessible to all volunteers and field staff

• The Society is not currently offering its own plan, but rather will evaluate proposals put forth by others and decide whether to support them

Threshold Questions

I. Does the proposal contain the essential components: adequacy, availability, affordability, and administrative simplicity?

II. Does the reform plan reduce or eliminate segmentation (“cherry picking”) of the health insurance market?

III. Is the financing of the reform adequate to sustain it?

Frame the Issue and Educate:Health Insurance Assistance Service (HIAS)

• Began April 2005 – Georgetown University partnering with ACS (NGRD and HP)

• Active in 28 states

• 17 health insurance specialists (and counting)

• More than 9,000 cases opened

• We will use these stories to show problems with the current health care system through the cancer lens

Partnerships and Collaborations

One compelling message…

Is the choice between losing your life and losing everything really a choice?

Fighting cancer is tough enough without having to fight for the help you need.

What kind of health care system is it if you have to beg for the opportunity to fight cancer?

What good is a health care system if it can’t help those who need it?

Access to Care Messaging

www.acscan.org

Access to Care Petition

• Aggressive advocacy work at the state and federal levels to expand access

• SCHIP• NBCCEDP • Establish CRC pilot screening & treatment

program for the uninsured; and ensure coverage for all Americans

• Fund patient navigators• Provide access to cessation and clinical

trials• Eliminate barriers to prevention in

Medicare • Preserve existing coverage

Advocacy:Current Work