Medicaid can and should play an active role in advancing health equity

Dihwa, Vimbainashe; Shadowen, Hannah; Barnes, Andrew J.

doi:10.1111/1475-6773.14069

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…For instance, insurance status is a SDOH that has been linked to disparities in lung cancer diagnosis and outcomes. In the U.S., Medicaid is a type of public insurance funded jointly by individual states and the federal government and provides health coverage to nearly 85 million Americans, including low income adults, elderly adults, and people with disabilities ( 8 ). Medicare, another public health insurance, funds Americans aged 65 and older, certain younger people with disabilities, and those with end-stage renal disease requiring dialysis or transplant.…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in staging, treatment, and mortality in non-small cell lung cancer

Duncan,

Al Nasrallah,

Nephew

et al. 2024

Transl Lung Cancer Res

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Background Black race is associated with advanced stage at diagnosis and increased mortality in non-small cell lung cancer (NSCLC). Most studies focus on race alone, without accounting for social determinants of health (SDOH). We explored the hypothesis that racial disparities in stage at diagnosis and outcomes are associated with SDOH and influence treatment decisions by patients and providers. Methods Patients with NSCLC newly diagnosed at Indiana University Simon Comprehensive Cancer Center (IUSCCC) from January 1, 2000 to May 31, 2015 were studied. Multivariable regression analyses were conducted to examine the impact of SDOH (race, gender, insurance status, and marital status) on diagnosis stage, time to treatment, receipt of and reasons for not receiving guideline concordant treatment, and 5-year overall survival (OS) based on Kaplan-Meier curves. Results A total of 3,349 subjects were included in the study, 12.2% of Black race. Those diagnosed with advanced-stage NSCLC had a significantly higher odds of being male, uninsured, and Black. Five-year OS was lower in those of Black race, male, single, uninsured, Medicare/Medicaid insurance, and advanced stage. Adjusted for multiple variables, individuals with Medicare, Medicare/Medicaid, uninsured, widowed, and advanced stage at diagnosis, were associated with significantly lower OS time. Black, single, widowed, and uninsured individuals were less likely to receive stage appropriate treatment for advanced disease. Those uninsured [odds ratio (OR): 3.876, P<0.001], Medicaid insurance (OR: 3.039, P=0.0017), and of Black race (OR: 1.779, P=0.0377) were less likely to receive curative-intent surgery for early-stage NSCLC because it was not a recommended treatment. Conclusions We found racial, gender, and socioeconomic disparities in NSCLC diagnosis stage, receipt of stage-appropriate treatment, and reasons for guideline discordance in receipt of curative intent surgery for early-stage NSCLC. While insurance type and marital status were associated with worse OS, race alone was not. This suggests racial differences in outcomes may not be associated with race alone, but rather worse SDOH disproportionately affecting Black individuals. Efforts to understand advanced diagnosis and reasons for failure to receive stage-appropriate treatment by vulnerable populations is needed to ensure equitable NSCLC care.

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Section: Introductionmentioning

confidence: 99%

Racial disparities in staging, treatment, and mortality in non-small cell lung cancer

Duncan,

Al Nasrallah,

Nephew

et al. 2024

Transl Lung Cancer Res

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“…Finally, Medicaid's critical role in supplying health coverage during the COVID-19 pandemic, especially for people of color, has increased recognition and salience of Medicaid's unique and essential position in advancing health equity. 12,13 Medicaid expansion and shifts in unemployment 14 driving significant growth in Medicaid enrollment have resulted in the program serving a diverse patient population with a complex array of needs. Facing an urgent necessity for innovative approaches to appropriately provide care, many states have identified MCOs as a lever to enhance health equity through the integration of health and social services to address nonmedical needs.…”

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confidence: 99%

Medicaid Privatization: Has the Invisible Hand Led Us Astray?

Saulsberry

2024

JCO Oncol Pract

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Medicaid Privatization: Has the Invisible Hand Led Us Astray? presents timely questions regarding our nation’s healthcare safety-net: (1) What are the consequences when states outsource the administration of Medicaid to private organizations with a profit motive?; (2) Can returning administrative responsibility back to state governments restore any losses to quality and equity experienced by previously privatized public programs?; and (3) Is it time to abandon Medicaid managed care altogether for state-operated fee-for-service or other alternative administrative arrangements?

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