30 June 2022

More money doesn’t always mean better outcomes

ASCO Equity Political Public health

Despite consistently spending about twice as much on cancer care and leading the world in terms of adopting new and novel technologies, cancer mortality in the US remains slightly higher than in Australia.  

According to American Cancer Society health service researcher Dr Robin Yabroff, the reason why the US doesn’t see better metaphoric bang for its buck lies in the underutilisation of some relatively cheap public health policies.  

Speaking at the American Society of Clinical Oncology Annual Meeting in Chicago, Dr Yabroff advocated for a “groundshot” approach to cancer care, as opposed to the high-risk, high-reward moonshot approach. 

In states which implemented a set of provisions passed under the Affordable Care Act in 2014, cancer mortality rates are lower.  

Importantly, the Act not only expanded access to health insurance for low-income people, it also eliminated cost sharing for tests like cervical cancer screening and preventative treatments like HPV vaccination and smoking-cessation counselling.  

Tobacco-control policies, cervical cancer screening and vaccination and health insurance coverage might be the old faithfuls of the preventative care landscape, but Dr Yabroff argues that this does not mean their usefulness has expired.  

“Each one of these interventions has decades of research to support their effectiveness,” she said. 

States which didn’t expand access have high lung cancer mortality rates, high prevalence of cigarette smoking, and high cervical cancer mortality rates. 

“[Implementing the changes was] associated with better access to care, earlier-stage cancer diagnosis among people diagnosed with cancer, improved survival following cancer diagnosis, and, importantly, reduced disparities … in stage and survival,” Dr Yabroff said.  

People with health insurance are more likely to have a regular doctor, receive regular screening, have timely follow up care and are less likely to be diagnosed with advanced disease.  

The effect is so great that non-insured people with stage one colorectal cancer had worse five-year survival than insured people diagnosed with stage two disease.  

“Typically, we think of stage at diagnosis as one of the most important prognostic factors,” she said.  

“And here, we see health insurance coverage can matter even more.” 

The concern, according to Dr Yabroff, is that there are now growing health disparities across the country depending on whether a person’s state of residence elected to implement the Affordable Care Act

“It is shocking, especially in a high-income country where we have incredible disparities and we know of effective interventions that can reduce those disparities [that we don’t act on injustice in health care],” she said.