Impact of Cancer Survivorship on Health Insurance and Employment Transitions

ROCHESTER, NY (05/22/2009)(readMedia)-- Cancer survivors, afraid of losing employment-related health insurance, refrain from making job changes, even after cancer treatment, according to a new study in the spring issue of INQUIRY.

The analysis, "Cancer Survivorship, Health Insurance, and Employment Transitions among Older Workers" (by Kaan Tunceli, Pamela Farley Short, John R. Moran, and Ozgur Tunceli), found that workers with health coverage at the time of their cancer diagnosis were no more likely to alter their employment situation following treatment than similar insured workers without cancer. On the other hand, results showed that cancer survivors with no employer-related health insurance---and thus nothing to lose---were more likely to stop working, switch jobs, or cut back from full-time to part-time work than other workers without health insurance.

The study, by a group from Penn State University, is important because of the growing number of U.S. cancer survivors---10.8 million in 2008---and the implications for future health care needs. The researchers looked at men and women, ages 55 to 64, who had survived all types of cancer (except superficial skin cancer) over the period 1997-2002; the sample came from cancer registries at three large Pennsylvania hospitals and one Maryland hospital. The study examined survivors an average of four years post-diagnosis.

While the findings imply that cancer survivors manage to stay insured by keeping jobs with health insurance, the fear of losing coverage constrains employment opportunities and other choices. "Not only are survivors handicapped in advancing their careers or pursuing leisure interests. . . but those who have continuing health problems as a result of cancer and treatment may be less able to accommodate changes in their health or functional status by changing jobs or cutting back on work," the authors write. "In these ways, survivors pay a higher 'price' for health insurance that affects their quality of life and adds to the economic burden of cancer."

The authors see a need for public policies that would provide affordable alternatives to job-related health insurance, spread risk more broadly and ease the burden on cancer survivors and others with chronic illness.

Other research papers in INQUIRY's spring issue:

"Effect of Prescription Drug Coverage on the Elderly's Use of Prescription Drugs," by Nasreen Khan and Robert Kaestner - This study found that coverage for prescription drugs was associated with a 4 percent to 10 percent increase in the use of prescription drugs, depending on the type of policy and generosity of benefits.

"Converting to Critical Access Status: How Does It Affect Rural Hospitals' Financial Performance?" by Pengxiang Li, John E. Schneider and Marcia M. Ward - Rural hospitals that converted to critical access status improved financially, experiencing significant increases in operating revenues and expenses, according to this analysis.

"Effects of Medicare Home Health Care Payment on Informal Care," by Ezra Golberstein, David C. Grabowski, Kenneth M. Langa, and Michael E. Chernew - This study found that lower-income individuals faced with restrictive payment caps for Medicare home health care offset the reduced Medicare home health visits by increasing use of informal care, possibly adding to their families' caregiving burden.

"How Do System-Affiliated Hospitals Fare in Providing Community Benefit?" by Jeffrey A. Alexander, Gary J. Young, Bryan J. Weiner and Larry R. Hearld - Results of this research indicate that, compared to independent hospitals, system affiliation is associated with less community benefit. However, the level and type of community benefit vary depending on the particular benefit examined and structural characteristics of the system with which a hospital is affiliated.

"Accuracy of Medicare Expenditures in the Medical Expenditure Panel Survey," by Samuel H. Zuvekas and Gary L. Olin - This paper examines underreporting and underrepresentation of high-expenditure cases in the Medical Expenditure Panel Survey (MEPS). Underreporting of expenditures was identified in all groups of Medicare beneficiaries in the sample, but the gaps were uniform and did not affect behavioral analyses. Simple adjustments could be made to the MEPS expenditure estimates to align them with aggregate sources.

Other spring features:

"Dialogue: Protecting the Hospital Safety Net" - This discussion by health care leaders focuses on challenges facing the hospital safety net and the health care it provides to millions of low-income and uninsured Americans (open access article available at http://www.inquiryjournalonline.org/inqronline/?request=get-document&issn=0046-9580&volume=046&issue=01&page=0007 )

"The View from Here: Health Reform Thaw in the Winter of Our Discontent" - Editor Alan Monheit examines some of the complex issues that Congress and the Obama administration face as they work toward comprehensive health care reform (open access article available at http://www.inquiryjournalonline.org/inqronline/?request=get-document&issn=0046-9580&volume=046&issue=01&page=0003 )

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INQUIRY, the journal of health care organization, provision, and financing, is a peer-reviewed scholarly publication. Now in its 46th year, it is published quarterly by Excellus Health Plan, Inc. Press releases and article abstracts are available on the INQUIRY Web site at www.inquiryjournal.org under "Current Issue Table of Contents."