Misleading Study on Role of Insurance in Access to Sarcoma Care

September 21, 2022

Summary: A study of sarcoma states in the title that “non-private” insurance slows access and worsens outcomes. Except that it turns out “non-private” means uninsured and Medicaid, and “private” includes Medicare. This flawed approach muddles discussion and sends the wrong message.

Patients With Bone Sarcomas of Lower-Extremity and Non-Private Insurance Linked with Higher Amputation Rates, Worse Outcomes
OncLive
September 5. 2022
By Gina Mauro

Amputation is an independent predictor of poor outcomes among patients with high-grade bone sarcoma of lower extremity, and non-private insurance was found to be linked with increased likelihood of amputation and an advanced stage at presentation in this patient population, according to results of a National Cancer Database study that were published in Annals of Surgical Oncology.

Study author R. Lor Randall, MD, who is the David Linn Endowed Chair for Orthopaedic Surgery and professor and chair of the Department of Orthopaedic Surgery, University of California Davis Health, discussed the analysis.

“This is an insightful study in that it shined a light on the fact that patients who are uninsured, or don’t have commercial payers, have a higher predilection for amputation for bone sarcomas around the lower extremity, which basically means that they’re probably getting access to care later than many other patients. This is a new finding, and it is basically saying that those who don’t have the resources and access that many do, or those with third-party payers, are really going to suffer worse outcomes because of that.”

Comment by: Don McCanne

Even the title of the original academic article, “Non-Private Health Insurance Predicts Advanced Stage at Presentation and Amputation in Lower Extremity High Grade Bone Sarcoma: A National Cancer Database Study“, suggests that insurance coverage must be private if we are to achieve timely access to care for urgent medical problems.

But this really reflects the incorrect definition of “non-private health insurance” in the original research. “Patients with no insurance and on Medicaid, and patients on Medicare and with private insurance were grouped together. This was done as patients presenting with no insurance to a healthcare facility are enrolled in Medicaid.”

Thus “privately insured” actually includes Medicare whereas “non-private” encompasses just uninsured and Medicaid patients – whom we already knew face significant barriers to care. (Their press release referred to Medicare as a non-commercial contract, further confusing matters.)

It is unfortunate that the authors framed this study as an inferiority of public versus private insurance. The real problem is not the lack of private insurance, it is rather the lack of universal timely access that a well-designed and well-managed public single payer could bring to all of us. The misleading methods and title used by the UC Davis team suggests that we still have ground to cover in disseminating the basics of health policy justice.