To investigate the relative contributions of individual insurance status and hospital payer mix (safety net status) to quality of care and survival for patients with cervical cancer. Researchers used the National Cancer Database to identify patients with cervical cancer diagnosed from 2004 to 2017. Patients were classified by insurance (uninsured/Medicaid/private/Medicare/other), and hospitals were grouped into quartiles depending on the proportion of uninsured/Medicaid patients (payer mix) (the highest quartile was identified as safety-net hospitals (SNHs) and the lowest as Q1 hospitals). Quality-of-care was assessed by adherence to evidence-based measures. A Cox proportional hazard Cox model examined individual contributions of insurance status and payer mix to survival. A total of 124,339 patients, including 11,338 uninsured (9.1%) and 27,281 Medicaid (21.9%) participants, treated at 1,156 hospitals were identified. Quality of care was not substantially different between hospital quartiles. Adjusting for patients’ clinical/demographic features, care at an SNH was linked with a 14% higher mortality (HR=1.14; 95% CL, 1.08–1.20) than at Q1 hospitals. Testing for individual insurance, uninsured patients had 32% greater mortality (HR=1.32; 95% CI, 1.26–1.38), and Medicaid beneficiaries had a 40% increase (HR=1.40; 95% CI, 1.35–1.44) compared to privately insured patients. Examining both payer mix and insurance, only individual insurance retained a significant impact on mortality. Individual insurance may be a more important predictor of survival than the site-of-care and hospital payer mix for women with cervical cancer. There is tremendous heterogeneity in results within hospitals based on individual insurance, independent of the hospital payer mix.
Source: sciencedirect.com/science/article/pii/S0090825822004279
