Access to health care is a major national concern. Additionally, there exists an imperative to focus on assuring not only access to basic health care but also high quality and affordable health care, especially for the most underserved communities. Given the increasing national, state and local focus on health care disparities, the lack of access to quality and affordable health care has been identified as a major contributor to health disparities in general and cancer disparities in particular.
To gain a better understanding of the factors that impact access to care, the study will:
- Examine demographic profiles of eight states and districts in the South Atlantic Region of the United States
- Identify factors that impact access to care in those states and the United States
- Identify key components of quality cancer care
- Review healthcare access policies, legislation, and regulation as well as cancer care plans in the region
- Develop an agenda for action for policymakers and cancer care organizations and associations to improve access to affordable quality cancer care
Methods and Data Sources:
A variety of data sources were utilized in this report including the American Cancer Society Cancer Facts and Figures; the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) and other data sources; Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System; U.S. Census Bureau; Kaiser State Health Facts; U.S. Department of Education; American College of Surgeons Commission on Cancer (CoC) and Comprehensive Adult Student Assessment System (CASAS). Available data were analyzed nationally and for each of the SAD states and the District of Columbia. Where data were available, comparisons to United States data are also provided. Frequency reports and proportions for a variety of health care access and cancer rate variables were reviewed.
A brief questionnaire was developed and administered to state cancer control plan staff within each area in the study. The purpose of this questionnaire was to determine responses to a set of key questions on access and cancer care and to determine whether policies, laws or regulations specific to cancer care existed in these states and whether plans were in progress to pursue additional legislation this year. Responses were received from all states. The responses were provided via email or telephone.
All of the states/districts analyzed in this study—Delaware, the District of Columbia, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia—have age-adjusted cancer death rates that exceed the U.S. rate of 195.7 deaths per 100,000 population per year. All of the states/districts rank in the top half of the states with the highest cancer death rates; West Virginia ranks fifth and the District of Columbia ranks first in the nation. Within the South Atlantic Region, variations in cancer screening, incidence rates, and death rates exist. There are also vast differences between the states in racial/ethnic composition, insurance rates, health care facilities, educational attainment, unemployment rates, income, household resources, geographic profiles, legislation, and cancer care plans.
Cancer screening practices, insurance rates, health care facilities, educational attainment, unemployment rates, income, household resources, and geographic profiles are important for the understanding of health care access and quality cancer care issues. Additionally, the evident differences in variables reported have a role in cancer disparities. Therefore we conclude that,
- Factors associated with access to health care are complex and are viewed as encompassing more than health insurance status.
- Multiple factors may be associated with decisions regarding type of treatment offered by the clinician and accepted by the patient.
- There is a need for a definition of quality cancer care which encompasses multiple components and domains of care.
- There is a need to develop the best methods to achieve quality care which may be achieved by standardizing treatment guidelines.
- Developing policies that create uniformity in cancer data reporting among all cancer agencies or registries may aid in the elimination of cancer disparities.
Claudia Baquet MD, MPH, Associate Dean for Policy and Planning, Professor of Medicine, and Professor of Epidemiology & Preventive Medicine, University of Maryland School of Medicine