Trends in Health Insurance Among Cancer Patients Receiving Radiation Therapy From 2008-2017.

In 2010, the Affordable Care Act (ACA) was enacted, which allowed for increased access to health insurance in the US. Since then, there was a decrease in uninsured patients including those with cancer receiving radiation therapy. In 2017, federal policy was changed in regards to the ACA including a shortened enrollment period and significantly reduced funding. We aimed to determine trends in rates of uninsured patients receiving radiation therapy within this time period in order to identify correlations of these policy changes.We obtained data from the National Cancer Database (NCDB) Public Benchmark Reports from 2008-2017 to investigate trends in uninsured cancer patients who received radiation therapy. This data was stratified by all patients who received radiation therapy, and calculated percentages of those without insurance from the years 2008 to 2017. We then identified trends of uninsured status by race including White, Black, Hispanic, Asian/Pacific, Native American, and unknown.According to the data, the percentage of patients receiving any kind of radiotherapy without health insurance declined over the years of 2008 to 2016 (2.3% to 1.76%). In 2017, the trend reversed with 1.78% of patients without health insurance. The percentage of patients who were uninsured that identified as White was lower than the entire population, and also declined from 2008 to 2016 (1.73% to 1.12%). In 2017, the trend reversed to 1.18%. The percentage of patients who were uninsured that identified as Black was higher than the entire population, but also declined from 2008 to 2016 (4.2% to 2.92%). In 2017, this trend continued to decline to 2.69%. The percentage of patients who were uninsured that identified as Hispanic was the highest of any group at any year. This group had an initial increase in uninsured patients from 2008 to 2012 (7.35% to 10%), then decrease by 2016 (7.78%). By 2017, this trend reversed again with 8% of the Hispanic population to be reported as uninsured.In the last decade, there has been an overall trend towards less uninsured patients receiving radiation therapy in the United States, with the exception of 2017, which saw a slight increase, disproportionately affecting the Hispanic population. While it is uncertain as to whether federal policy changes in the promotion and administration of ACA affected these trends, this data mirrors observations in other series looking at un-insurance in cancer survivors. Further work is indicated to determine if this trend continues throughout the remainder of the past federal administration. In the meantime, it is essential to acknowledge the continued racial health disparities increase efforts in making access to cancer care more equitable.

Duke Scholars

Author Haley A Moss Obstetrics and Gynecology, Gynecologic Oncology

Author Junzo Paul Chino Radiation Oncology