Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Abstract

Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.

Keywords: Introduction; colorectal surgery; disparities; insurance; underinsured; uninsured.

Fig. 1

Estimated distribution of U.S. population by insurance coverage type and adequacy of coverage. On the left, the breakdown of the U.S. population by insurance coverage type is estimated and, on the right, adequate insurance coverage is estimated. All numbers indicate the approximate number of U.S. individuals in millions, and the percentages indicate the proportion of the U.S. population represented. Among these coverage types, approximately 23 and 19% of individuals with private insurance and Medicare, respectively, have out-of-pocket costs that exceed 5% of their household income, indicating underinsurance. Estimates are based on reports from the 2022 U.S. Census and the Commonwealth Fund.

Fig. 2

Barriers to care for the uninsured and underinsured along the colorectal cancer control continuum. The National Cancer Institute's Cancer Control Continuum was modified as shown here for relevance to colorectal cancer care. Barriers to optimal care exist, resulting in poorer outcomes for uninsured and underinsured patients, at each point along the continuum. Examples are shown here.