title: Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS).
abstract: BACKGROUND
  Lack of health insurance is a key barrier to accessing care for chronic conditions and cancer screening. The influence of insurance type (private, public, none) on survivor-focused and general preventive health care in adult survivors of childhood cancer was examined.
  
  
  METHODS
  The Childhood Cancer Survivor Study is a retrospective cohort study of childhood cancer survivors diagnosed between 1970 and 1986. Among 8425 adult survivors, the relative risk (RR) and 95% confidence interval (CI) of receiving survivor-focused and general preventive health care were estimated for uninsured (n = 1390) and publicly insured (n = 640), compared with for the privately insured (n = 6395)
  
  
  RESULTS
  Uninsured survivors were less likely than those privately insured to report a cancer-related visit (adjusted RR, 0.83; 95% CI, 0.75-0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71-0.98). Uninsured survivors had lower levels of utilization in all measures of care in comparison with privately insured. In contrast, publicly insured survivors were more likely to report a cancer-related visit (adjusted RR, 1.22; 95% CI, 1.11-1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18-1.70) than were privately insured survivors. Although publicly insured survivors had similar utilization of general health examinations, they were less likely to report a Papanicolaou test or a dental examinations
  
  
  CONCLUSIONS
  Among this large, socioeconomically diverse cohort, publicly insured survivors utilize survivor-focused health care at rates at least as high as survivors with private insurance. Uninsured survivors have lower utilization of both survivor-focused and general preventive health care.
authors.affiliation: Department of Pediatrics, University of California Los Angeles, Los Angeles, California 90095, USA. jcasillas@mednet.ucla.edu
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Casillas
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Castellino
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Isac S F
authors.initials: IS
authors.lastname: Lima
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D006278:Medicare; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017741:Survivors; D014481:United States