title: Effects of type of health insurance coverage on colorectal cancer survival in Puerto Rico: a population-based study.
abstract: Colorectal cancer represents a major health problem and an important economic burden in Puerto Rico. In the 1990's, the Commonwealth of Puerto Rico implemented a health care reform through the privatization of the public health system. The goal was to ensure access to health services, eliminate disparities for medically indigent citizens and provide special coverage for high-risk conditions such as cancer. This study estimates the 5-year relative survival rate of colorectal cancer and the relative excess risk of death in Puerto Rico for 2004-2005, by type of health insurance coverage; Government Health Plan vs. Non-Government Health Plan. Colorectal cancer in advanced stages was more common in Government Health Plan patients compared with Non-Government Health Plan patients (44.29% vs. 40.24 had regional extent and 13.58% versus 10.42% had distant involvement, respectively). Government Health Plan patients in the 50-64 (RR = 6.59; CI: 2.85-15.24) and ≥65 (RR = 2.4; CI: 1.72-4.04) age-groups had the greater excess risk of death compared with Non-Government Health Plan patients. Further studies evaluating the interplay of access to health services and the barriers affecting the Government Health Plan population are warranted.
authors.affiliation: Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Ortiz-Ortiz
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ramírez-García
authors.affiliation: University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
authors.forename: Marcia
authors.initials: M
authors.lastname: Cruz-Correa
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Moraima Y
authors.initials: MY
authors.lastname: Ríos-González
authors.affiliation: Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Ana Patricia
authors.initials: AP
authors.lastname: Ortiz
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011647:Puerto Rico; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States