Lung Cancer Care Before and After Medicare Eligibility

Abstract

Uninsured and underinsured near-elderly may not have timely investigation, diagnosis, or care of cancer. Prior studies suggest Medicare eligibility confers significant and substantial reductions in mortality and increases in health service utilization. We compared 2245 patients diagnosed with lung cancer at ages 64.5 to 65 years and 2512 patients aged 65 to 65.5 years, with 2492 patients aged 65.5 to 66 years (controls) in 2000 to 2005. Compared with controls, patients diagnosed with lung cancer before Medicare eligibility had no statistically significant differences in cancer stage, time to treatment, type of treatment, and survival. Study power was sufficient to exclude mortality reductions and health service utilization changes of the magnitude found in prior work, suggesting that typically, appropriate lung cancer care may be sought and delivered regardless of insurance status.

Keywords: Medicare; access; cancer; care; coverage; insurance; near elderly; uninsured.

Figure 1.

Cohorts and frequency of cases by cancer type, age, and eligibility.

Figure 2.

Cumulative incidence for therapy start, adjusted for death as competing risk, for pre-Medicare eligible (64.5-65 years old) and control cohorts (65.5-66 years old). Note. SEER = Surveillance, Epidemiology, and End Results; OASI = Old Age Survivors Insurance.

Figure 3.

Cumulative incidence of death from lung cancer and death from other causes for pre-Medicare eligible (64.5-65 years old) and control cohorts (65.5-66 years old). Note. SEER = Surveillance, Epidemiology, and End Results.

Figure A1.

Complete distribution of lung cancer cohort sizes, by age in months. Note. Vertical line at 780 months corresponds to 65 years of age.

Figure A2.

Lung cancer cohort sizes, by age in months around 65th year of age.