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State-Level Insurance Reform Improved Access for Patients With CRC in Massachusetts


A study published in the Journal of Clinical Oncology found an increased rate of resection and a reduction in the probability of emergent resection for colorectal cancer (CRC) as a result of insurance expansion in Massachusetts.

The healthcare reform law passed in Massachusetts in 2006, to provide health insurance to all, has served as a model of sorts for the Affordable Care Act. A study recently published in the Journal of Clinical Oncology determined the impact of this insurance expansion on care of patients with colorectal cancer (CRC) and found an increased rate of resection and a reduction in the probability of emergent resection for CRC.

The state law promulgated basic health coverage for every resident, free health insurance for residents earning less than 150% of the federal poverty level, and employer-based insurance for businesses with more than 10 employees. And the plan was successful—within 6 years of the state law being passed, 98% of residents in Massachusetts had insurance coverage. To specifically establish impact of this health law on CRC outcomes, researchers at the Massachusetts General Hospital used data from the Hospital Cost and Utilization Project State Inpatient Databases to select patients with CRC covered by private health insurance, government-subsidized insurance, or self-pay.

The study period covered the decade between 2001 and 2011 and included 17,499 CRC patients within Massachusetts and 144,253 patients in 3 control states, between the ages of 18 and 65 years. Patients younger than 18 years, and those covered by Medicare, were excluded from the analysis.

The analysis found that prior to state reform in 2006, patients in the self-pay and government-subsidized cohorts had lower rates of surgical resection compared with patients enrolled in private insurance. However, following insurance expansion, the rate of resection increased by 44% (rate ratio, 1.44; 95% CI, 1.23-1.68; P <.001). Additionally, the probability of emergent admissions was predicted to reduce by 6.21 percentage points compared with control states.

These results are very encouraging, considering the dismal outcomes associated with CRC, which could stem from disparities in access, lack of insurance, site of care, and socioeconomic issues. These, in turn, are associated with patients presenting with a more advanced disease at the time of diagnosis.

The authors offer the following explanation for their results: resection is a viable option when patients present at an early stage of CRC—newly insured patients may be more willing to get screened at a clinic or hospital with earlier signs of the disease, resulting in admissions for surgically treatable tumors. However, the researchers did observe disparity in the probability of resection based on payer status. They concluded, that “expanded insurance coverage may help facilitate more equitable access to and receipt of cancer care.”


Loehrer AP, Song Z, Haynes AB, Chang DC, Hutter MM, Mullen JT. Impact of health insurance expansion on the treatment of colorectal cancer [published online October 3, 2016]. J Clin Oncol. doi: 10.1200/JCO.2016.68.5701.

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