Income is an important variable in the quality of health care that people receive, and should be included in systems that monitor health status, writes Roger T. Anderson, Ph.D., of Wake Forest University Baptist Medical Center, in a commentary in the October issue of Women’s Health Issues.
“Despite federal initiatives to eliminate disparities in health care, key data that are necessary to monitor success are not collected routinely,” says Anderson. “We cannot manage what we don’t measure.” Anderson, an associate professor of public health sciences, says that proposed legislation, the “Cancer Survivorship Research and Quality of Life Act of 2003,” offers the perfect opportunity to begin to collect this vital information. The bill would expand current cancer surveillance systems and develop a program to monitor and evaluate quality cancer care and survivorship.
“This is an ideal time to address the long-neglected need to assess and report on the quality of care of women with cancer – especially those with financial hardship and those who are underserved minorities,” says Anderson. “Currently, the health care of the uninsured is virtually invisible.”
Anderson proposes that the cancer registry – and other tracking systems – include insurance status and income level as indicators of poverty.
“Decades of research on how social class links to health outcomes have shown that a lack of health insurance, living in impoverished neighborhoods, and social and contextual barriers to accessing health care place people in poverty at a disadvantage with respect to preventing disease, managing illness and survival,” said Anderson.
He said that poverty is an especially relevant issue in women’s health because the number of uninsured women has grown three times faster than the number of uninsured men. In addition, programs that support health insurance for the poor, such as Medicaid, are threatened by state budget deficits.
Anderson says there are several reasons that poverty can affect quality of cancer care. Low-income women may have a narrower choice of health care settings and may be more likely to encounter sites that are lagging behind in professional practices that are demanded by more affluent patients. For example, one study showed that use of breast conserving therapy for early stage cancer was most used by affluent women and least by inner city or rural women. Low-income women may also be less likely to take advantage of newer, complex therapies – either because multiple visits are required or because they are less educated about standards of care.
Uninsured women with cancer may simply have a difficult time getting the full range of healthcare services.
“Without better data, we cannot know why some patients do not receive certain treatments or therapies that are considered standard or beneficial,” said Anderson. “Collecting information on poverty status will help pinpoint gaps in care that financially needy may face, and raise awareness to correct it.”
Anderson is principal investigator of studies on patterns of care for breast cancer in North Carolina, funded by the American Cancer Society and the National Cancer Institute.
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