Effects of private health insurance coverage gains on colorectal cancer outcomes: a modeling study

Lack of health insurance limits access to health care, leading to potentially preventable inequities in health outcomes. This modelling study estimates the impact of providing insurance to currently uninsured individuals on colorectal cancer (CRC) outcomes in the US.

The MISCAN-Colon model was adapted to an uninsured population aged 40-100 during 2025-2055, using age-specific estimates from national data sources for screening, stage distribution, survival and all-cause mortality by insurance status (ages 40-64: privately insured vs. uninsured; ages 65-100: Medicare and private coverage vs. Medicare only). The effects of this uninsured population gaining health insurance coverage in 2025 were compared with the same population remaining uninsured for CRC incidence, mortality, and costs. Both groups were assumed age-eligible for Medicare coverage at 65 years.

In an uninsured population, the model predicted 170 CRC cases and 73 deaths per 100,000 in 2055. If this population gained private insurance, up to 15 (8.9%) cases and 22 (30.7%) deaths per 100,000 could be averted by 2055. Although insurance gains would decrease treatment costs by $1.37 million per 100,000 (-4.8%) through prevention and earlier diagnoses, total CRC-related costs would increase by $1.29 million per 100,000 (+3.7%) due to increased screening costs ($2.66 million per 100,000, +41.7%).

If the previously uninsured population gained health insurance, CRC incidence and CRC mortality could be reduced substantially because of improved access to care. Assuming analogous improvements for other cancers, this case study provides an example for the potential benefits of gaining health insurance on mitigating health disparities.