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Insurance Status Impacts Access to Quality Surgical Care, Study Finds

Doctors completing a surgery.

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Key Takeaways

  • A recent study found that uninsured, Medicare, and Medicaid patients are less likely to have surgeries at high-volume hospitals.
  • High-volume hospitals are associated with better patient outcomes. 
  • The ACA increased healthcare access, but millions of people remain uninsured or unable to access high-quality care for various reasons. 
  • Patients, especially those who have a preexisting condition, such as cancer, benefit from having a comprehensive understanding of how health insurance works. 

A recent study published by the American Cancer Society suggests that health insurance status may play a role in whether you have access to high-quality health care, particularly surgical care. This finding highlights the long-existing health care inequalities in the United States.

According to the October study, among patients diagnosed with breast, prostate, lung, or colorectal cancer from 2004 to 2016, those with private insurance were more likely to receive surgical care at high-volume hospitals than patients who were uninsured or had Medicare or Medicaid.

What's a High-Volume Hospital?

High-volume hospitals frequently perform specific, complex surgical procedures. Regularly performing surgeries adds to the expertise of both the surgeon and the hospital, and leads to better patient outcomes.

In contrast, low-volume hospitals don't regularly perform these procedures, leading to a lack of experience among the surgeon and the hospital. For this reason, research has linked low-volume hospitals to increased mortality and complication rates from surgery. 

Despite this disparity, the researchers say that after the Affordable Care Act (ACA) was enacted in 2010, the odds of receiving care at a high-volume hospital increased for colorectal patients who were uninsured or had Medicaid.

"At the moment, our greatest concern is the fate of the Affordable Care Act," Joanna Fawzy Morales, Esq, a cancer rights attorney and CEO of Triage Cancer, tells Verywell. "While not perfect, the ACA provides crucial protections for people in the cancer community."

What This Means For You

It's essential to know how your insurance status may impact your care, especially if you're considering getting surgery. When looking for a hospital to have your surgery, ask the surgeon and hospital how many times they have performed your procedure in the last two years. In general, it's best to go to a highly-experienced surgeon and hospital. 

How the ACA Improved Access to Healthcare

The ACA provides greater health care access for uninsured people and people who have Medicare or Medicaid. According to the Kaiser Family Foundation (KFF), there are several improvements attributable to the ACA:

  • In 2019, the number of uninsured people was significantly lower than it was in 2010.   
  • Health insurance companies can no longer deny people with preexisting conditions, such as cancer, from enrolling in coverage.
  • The ACA also mandates that all major medical plans offer ten essential benefits to ensure high-quality care, including maternity care, preventative services, and prescription drug coverage.

Despite these accomplishments, however, the ACA hasn't managed to solve all health care access issues. 

Millions of People Still Lack Access to High-Quality Care

According to KFF, in 2019, 28.9 million people in the U.S. were uninsured. Fast forward to 2020, and the current COVID-19 pandemic only further compounds this problem.

"Many people (more than 50%) have health insurance related to their employer, [and] with job loss comes insurance loss," Jan K. Carney, MD, MPH, professor of Medicine and associate dean for Public Health at the University of Vermont Larner College of Medicine, tells Verywell. 

Before the COVID-19 pandemic, six out of 10 uninsured people were eligible for financial assistance through Medicaid expansion under the ACA. However, as of 2020, only 37 states (including Washington D.C.) have opted for this expansion. Therefore, millions of people continue to go without health insurance due to high premium costs and a lack of financial assistance from their respective state governments.

In short, having health insurance is a vital step towards accessing high-quality health care. However, even those who are insured may face barriers in regards to health care access.

Other Barriers to Accessing Health Care

"There are many reasons why people do not have access to different types of health care, both primary and specialty care," Carney says. A few of those reasons include access to transportation and geographic location, she says.

For example, a patient may have Medicare but may not have the transportation to go to a high-volume hospital for surgery. Therefore, they may feel obligated to go to the nearest hospital in their area, even though this hospital may lack the experience needed to perform this patient's specific surgery.

For lower-income patients who have Medicaid, making decisions regarding surgery may prove even more challenging.

"They may not have access to paid sick leave, so taking time off for doctors' appointments, surgery, and recovery, means not getting paid and likely losing their jobs," Morales says. Her nonprofit organization, Triage Cancer, provides education on practical and legal issues that affect patients diagnosed with cancer and their caregivers. 

These issues include helping patients understand health insurance so that they avoid getting trapped in a web of confusion.

Patient Education May Improve Access  

According to Morales, "access to care can depend on understanding how health insurance works."

She says that many people don't know that most health insurance companies are required to provide coverage for many services, including:

  • Preventative services
  • Second opinions regarding a diagnosis
  • Routine costs of care during a clinical trial 

Morales adds that people are likely to forgo these potentially life-saving benefits due to the perceived cost. "Many people do not know that they may have multiple options, how to make choices between those options, or how to use their policies to their maximum potential," she says.

Having an understanding of health insurance is crucial not only for physical health but also for financial health. 

“Not having an understanding of networks, and choosing the wrong provider can lead to astronomical out of pocket costs," she says. "So even if people are able to access care, they may end up paying too much and in financial ruin."

Health insurance is a complicated matter and can carry implications regarding the care you receive, as the study suggests. Healthcare reform continues to evolve in the U.S. Still, in the meantime, you can educate yourself on how your insurance plan works, or what resources are available in your state to afford health insurance coverage. 

 

 

 

 

 

 

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Nabi J, Tully K, Cole A et al. Access denied: The relationship between patient insurance status and access to high‐volume hospitals. Cancer. 2020. doi:10.1002/cncr.33237

  2. John Hopkins Medicine. Patient safety & quality: surgical volumes. Updated November 2020.

  3. Kaiser Family Foundation. Key facts about the uninsured population. Updated November 6, 2020.

  4. Kaiser Family Foundation. Pre-existing condition prevalence for individuals and families. Updated October 4, 2019.

  5. Kaiser Family Foundation. Quick take: essential health benefits: what have states decided for their benchmark? Published December 7, 2012.

  6. Center on Budget & Policy Priorities. Chart book: the far-reaching benefits of the Affordable Care Act’s Medicaid expansion. Updated October 21, 2020.