title: Inadequate access to surgeons: reason for disparate cancer care?
abstract: OBJECTIVE
  To compare the likelihood of seeing a surgeon between elderly dually eligible non-small-cell lung cancer (NSCLC) and colon cancer patients and their Medicare counterparts. Surgery rates between dually eligible and Medicare patients who were evaluated by a surgeon were also assessed.
  
  
  METHODS
  We used statewide Medicaid and Medicare data merged with the Michigan Tumor Registry to extract a sample of patients with a first primary NSCLC (n = 1100) or colon cancer (n = 2086). The study period was from January 1, 1997 to December 31, 2000. We assessed the likelihood of a surgical evaluation using logistic models that included patient characteristics, tumor stage, and census tracts. Among patients evaluated by a surgeon, we used logistic regression to predict if a resection was performed.
  
  
  RESULTS
  Dually eligible patients were nearly half as likely to be evaluated by a surgeon as Medicare patients (odds ratio [OR] = 0.49; 95% confidence interval = 0.32, 0.77 and odds ratio = 0.59; 95% confidence interval = 0.41, 0.86 for NSCLC and colon cancer patients, respectively). Among patients who were evaluated by a surgeon, the likelihood of resection was not statistically significantly different between dually eligible and Medicare patients.
  
  
  CONCLUSIONS
  This study suggests that dually eligible patients, in spite of having Medicaid insurance, are less likely to be evaluated by a surgeon relative to their Medicare counterparts. Policies and interventions aimed toward increasing access to specialists and complete diagnostic work-ups (eg, colonoscopy, bronchoscopy) are needed.
authors.affiliation: Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, 1008 Clay Street, Richmond, VA 23298-0203, USA. cjbradley@vcu.edu
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.forename: Bassam
authors.initials: B
authors.lastname: Dahman
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016013:Likelihood Functions; D016015:Logistic Models; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008484:Medicaid / Q000458:organization & administration; D006278:Medicare / Q000458:organization & administration; D008824:Michigan / Q000453:epidemiology; D018579:Patient Selection; D017149:Private Sector; D012042:Registries; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D014481:United States