Medicaid expansion linked to increase in palliative care for patients with advanced cancer
Click Here to Manage Email Alerts
Key takeaways:
- Medicaid expansion resulted in a nearly 2% increase in palliative care among patients from eligible states.
- Patients with pancreatic, colorectal, lung, oral cavity and pharynx cancers appeared to see the largest increase.
Medicaid expansion under the Affordable Care Act appeared associated with an increase in use of palliative care by individuals with newly diagnosed stage IV cancers, according to data published in Health Affairs.
Despite the increase, palliative care usage remained below recommended levels between 2010 and 2019, researchers wrote.
“We’ve seen evidence showing improvements in access to cancer care and cancer outcomes associated with Medicaid expansion in the past years, and the findings from this study are consistent with earlier reports indicating a promising role for expanding Medicaid eligibility in improving access to high-quality cancer care,” Xuesong Han, PhD, scientific director of health services research in American Cancer Society's surveillance and health equity science department, told Healio. “One thing that surprised me was that we found although receipt of palliative care by patients with advanced-stage cancers increased nationwide between 2010 and 2019, it remained suboptimal, with only one-fifth of patients for whom it is deemed appropriate receiving it. This highlights the importance of continuing efforts to improve access to palliative care for patients with advanced-stage cancers at all levels — patients, providers, organizations and policy can all play a role in this.”
Background and methodology
Clinical guidelines endorse early palliative care for patients with newly diagnosed advanced cancers; however, receipt of such care remains low throughout much of the United States.
Researchers conducted a retrospective study examining the association of Medicaid expansion through the ACA with receipt of such care among patients with newly diagnosed advanced-stage cancers. Forty states and Washington, D.C., had adopted Medicaid expansion at the time of the study.
Researchers obtained data through the National Cancer Database from over 1,500 Commission on Cancer-accredited hospitals, identifying individuals aged 18 to 64 years with newly diagnosed, first primary stage IV cancers between 2010 and 2019.
Results, next steps
The percentage of eligible patients who received palliative care as part of first-course treatment increased from 17% before expansion to 18.9% after expansion in Medicaid expansion states and from 15.7% before to 16.7% after in non-Medicaid expansion states (adjusted net increase in expansion states, 1.3%; 95% CI, 0.9-1.7).
Increases in palliative care associated with Medicaid expansion appeared largest among patients with advanced pancreatic, colorectal, lung, oral cavity and pharynx cancers, as well as non-Hodgkin lymphoma.
Additional efforts are needed to increase access to palliative care, according to researchers.
“There are unanswered questions related to this topic that can be addressed in future research,” Han said. “What’s the role of managed care — becoming the dominant Medicaid delivery system — in utilization of guideline-recommended palliative care? Have the CMS innovation demonstration programs under the ACA contributed to improvements in receipt of palliative care? Are there spillover effects from Medicaid expansion on receipt of palliative care among populations not targeted by the policy? Are there intertwined effects of insurance coverage and other determinants of palliative care use?”
For more information:
Xuesong Han, PhD, can be reached at xuesong.han@cancer.org.
Collapse
Han X, et al. Health Aff (Millwood). 2023;doi:10.1377/hlthaff.2023.00035.
Click Here to Manage Email Alerts