Health Insurance Type and Lung Cancer Stage Shift Following Coverage of Screening

Area of Science:

• Oncology
• Health Services Research
• Public Health

Background:

• Lung cancer screening guidelines have evolved, with insurance coverage playing a crucial role in patient access.
• Understanding how different insurance types influence the stage at diagnosis is vital for effective screening programs.

Purpose of the Study:

• To investigate the impact of lung cancer screening insurance coverage on the stage of lung cancer diagnosis.
• To analyze variations in diagnostic stage shifts across different health insurance categories.

Main Methods:

• Difference-in-differences (DID) analysis comparing pre-coverage (2007-2014) and post-coverage (2015-2019) periods.
• Utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database for non-small cell lung cancer patients aged 55-77.
• Categorized insurance types including private, Medicare (FFS, Medicare Advantage), Medicaid, military health plans, and uninsured.

Main Results:

• A significant increase in early-stage lung cancer diagnosis was observed among Medicaid patients post-coverage compared to uninsured individuals (DID = 2.88 ppt).
• No significant shifts in early-stage diagnosis were found for patients with private insurance, Medicare, or military health insurance.
• Within Medicaid, managed care beneficiaries showed a greater shift to early-stage diagnosis (DID = 8.22 ppt) compared to FFS.
• Dual Medicaid enrollment among Medicare FFS beneficiaries was associated with a smaller increase in early-stage diagnosis (DID = -4.40 ppt).

Conclusions:

• Lung cancer screening coverage's benefit in shifting diagnoses to earlier stages varies significantly by insurance type.
• Targeted interventions are needed to overcome patient, provider, and system-level barriers to lung cancer screening.
• Ensuring equitable access and utilization of screening is essential to translate coverage into improved patient outcomes.