title: Health insurance coverage and cost barriers to needed medical care among U.S. adult cancer survivors age<65 years.
abstract: BACKGROUND
  The health insurance and cost barriers to care among cancer survivors age <65 years were examined.
  
  
  METHODS
  Using the 1998 and 2000 National Health Interview Survey, survivors ages 18 to 64 years (n=1718) were compared with similarly aged adults without cancer (n=50,276) to examine health insurance and reported delayed/missed needed medical care within the previous year because of cost. Findings were initially adjusted for age, sex, race, and ethnicity, and further adjusted for employment, income, health status, marital status, and region.
  
  
  RESULTS
  Before adjustment, survivors were less likely to be uninsured (12.4% vs. 18.0%) and more likely to have public insurance (11.2% vs. 6.2%). After initial adjustment, survivors were as likely to lack insurance, less likely to have private insurance, and more likely to have public insurance. After further adjusting, differences in being uninsured were found to be small, differences in having private insurance were eliminated, and differences in having public insurance were reduced. Survivors most likely to lack insurance were younger, female, African-American, or lower income. Survivors, particularly uninsured or publicly insured survivors, were more likely to delay/miss care because of cost. Overall, 20.9% of survivors, including 68% of uninsured survivors, reported delaying/missing needed care.
  
  
  CONCLUSIONS
  Health insurance coverage among cancer survivors age<65 years appears to be comparable to that of adults of similar age, sex, race, and ethnicity, but survivors may more likely be publicly insured. Differences are attributable in part to employment, income, and health status, factors potentially influenced by cancer. Unmet medical care needs because of cost were common among survivors, particularly uninsured survivors.
authors.affiliation: Division of Cancer Prevention and Control, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. bzo8@cdc.gov
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Coates
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Uhler
authors.forename: Linda G
authors.initials: LG
authors.lastname: Alley
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics*; D017741:Survivors; D014481:United States