Young patients at risk in private health care systems
- From: "Lance" <lachenicht@xxxxxxxxxx>
- Date: 2 Apr 2006 15:37:28 -0700
Young patients more likely to die in countries where health care is
funded by private insurance
London, UK-- Countries that have national health services easily
accessible to people of all ages are more likely to have better
survival rates for their teenagers and young adults (TYAs) with cancer,
than are countries where individuals have to pay for their own medical
insurance.
This is the suggestion that arises from new research presented at the
4th International Conference on Teenage and Young Adult Cancer Medicine
today (Friday 31 March 2006), in which the health care systems of the
United States of America and Australia were compared.
Professor Archie Bleyer told the conference, organised by Teenage
Cancer Trust, that Australia's system of health insurance for all,
regardless of age, meant that TYAs were more likely to survive cancer
in Australia than they were in the USA.
Prof Bleyer, who is medical advisor at the Cancer Treatment Center, St
Charles Medical Center, Bend, Oregon, said: "However, both countries
have a lower survival rate for their TYAs than for their younger and
older patients, proving that TYAs remain the most neglected group of
cancer patients across the globe.
"Our previous research has shown that the survival of older teenagers
and young adults with cancer in the United States has lagged behind
progress in younger and older patients. We found that diagnosis was
delayed in TYAs who either lacked health insurance or had inadequate
insurance, and therefore this lack of progress might be due to the USA
health care system and less expected in countries with national health
insurance.
"During the past year we have compared survival of TYAs in the USA with
those in Australia, a country similar in many demographics to the USA,
but with health insurance provided to all citizens regardless of age.
"From 1982 to 1998, the rate of improvement in the five-year survival
from invasive cancer in Australia exceeded that which occurred in the
USA, such that by the late 1990s, TYAs in Australia had an overall
five-year cancer survival that was higher than in the USA. The deficit
begins at 16 and ends at 55, the same years that national health
insurance is not available in the USA. It ranges from 5% for 18 to 25
year-olds to 12% for those aged 30 to 35. This difference suggests that
the health care system in Australia, with universal health insurance,
was able to provide better cancer care to its TYAs.
"The advantage for Australian TYAs was not apparent in their children
or older adults with cancer. This suggests that the need for private
health insurance in the USA is responsible for the worse survival of
TYAs, in that children and older adults in the USA are more adequately
insured than TYAs."
In the USA the greatest improvement in survival occurred amongst
patients aged over 65 for whom national health insurance is provided.
Prof Bleyer said: "Both countries, however, had a lower rate of
improvement in the five-year cancer survival rate among TYAs than in
either younger or older patients, albeit the relative deficit was
greater in the USA than in Australia.
"These comparisons indicate that the relative lack of progress in
cancer outcome among TYAs in the USA is due, at least in part to the
lack of health insurance," he said.
However, he warned that even in countries where there was national
health insurance for all, this didn't necessarily guarantee access to
good diagnosis and treatment for cancer patients, and particularly not
for TYAs.
"Good health care systems make a huge difference in prolonging survival
and reducing deaths amongst TYAs with cancer," he said. "The failure to
improve survival amongst 15 to 29-year-olds over the last quarter of a
century is striking and there are reasons that are common between
different countries. These include the tendency for adolescents and
young adults to wait longer before consulting a doctor about symptoms,
lack of a regular and usual source of primary care, delays in diagnosis
by doctors not used to seeing young people with cancer, the wide
spectrum of cancers contracted by TYAs, physicians poorly trained in
caring for TYAs with cancer, and, most importantly, the lack of
participation in clinical trials for this age group."
Some countries belatedly were waking up to this problem, he said. In
the UK, the National Institute for Health and Clinical Excellence
(NICE) issued new guidance for the treatment of under-19s in August
2005. "In the USA the National Cancer Institute has initiated a major
review of the national status of cancer in this age group. Known as a
Progress Review Group, the nation's experts will evaluate all available
data, determine the severity and potential solutions, and provide an
official report of recommendations," he said.
"In addition, the President's Cancer Panel is working on a similar
report on the survivorship of young Americans with cancer. Both efforts
include a review of the role of health insurance and health care
delivery systems in the new medical frontier that is TYA oncology."
Full text at EurekAlert
http://www.eurekalert.org/pub_releases/2006-03/tct-ypm033006.php
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