School of Medicine and Health Sciences Poster Presentations

Public Insurance is not a Barrier to Colorectal Cancer Screening

Poster Number

234

Document Type

Poster

Publication Date

3-2016

Abstract

Introduction: The Affordable Care Act (ACA) provided states and Washington D.C. the option to expand Medicaid coverage to beneficiaries with incomes up to 138% of the Federal Poverty Line. Expanded coverage went into effect in Washington D.C. on January 1, 2014. Insurance coverage, however, does not necessarily equate to access. This holds especially true for low-income, public insurance such as Medicaid as fewer providers accept this insurance. Colorectal cancer (CRC) screening is important for detecting precancerous colonic lesions and preventing progression to future disease. This study compares the rate of CRC screening in appropriately aged individuals on public insurance and in their privately insured counterparts.

Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous health survey. The exposition was hosted at a community center in an urban location with a historically African American predominant population. The survey included questions on demographic information, insurance information, access to primary care, and CRC screening. Data from the survey was analyzed in a Microsoft Excel database. Insurance types were classified as public insurance (Medicaid and other District government sponsored programs) or private insurance (Blue Cross, Aetna, etc.). Surveys were excluded if specific questions of interest were left unanswered. Statistical analysis was performed using Fisher’s exact test, with significance set at P<0.05. The study was approved by the university’s institutional review board.

Results: There were 102 participants with an average age of 42.4. Ninety-three (91.2%) identified as African American. Fifty-six (54.9%) respondents had public insurance and 28 (27.4%) had private insurance. Twenty-nine (51.8%) of those with public insurance enrolled within the past 18 months, 25 (44.6%) enrolled earlier, and 2 participants did not respond. Given the predominantly African American population and the recent CRC screening recommendations advising this population to begin screening at age 45, a subgroup analysis was conducted in survey participants 45 years and older. Of the thirty-nine participants 45 years-old and above, 22 (56.4%) had public insurance and 17 (43.6%) had private insurance. Thirteen (59%) publically insured responders received CRC screening while 12 (70.5%) responders on private insurance had received CRC screening (p=0.518).

Conclusions: This study showed that public insurance was not associated with significantly decreased rates of CRC screening when compared with respondents with private insurance. In this study at a Washington, D.C. health expo, a majority of respondents with public insurance had acquired it in the previous 18 months, correlating temporally with ACA Medicaid expansion. While there has been concern that, despite having insurance, public insureds may have difficulty accessing health care, this did not appear to be a barrier to CRC screening in this population. Limitations of our study include a small sample size and a predominantly African American population. Additionally, the District of Columbia had, prior to Medicaid expansion, a greater-than-typical safety net insurance program, so referral patterns and provider acceptance may already have been established.

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Presented at: GW Research Days 2016

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Public Insurance is not a Barrier to Colorectal Cancer Screening

Introduction: The Affordable Care Act (ACA) provided states and Washington D.C. the option to expand Medicaid coverage to beneficiaries with incomes up to 138% of the Federal Poverty Line. Expanded coverage went into effect in Washington D.C. on January 1, 2014. Insurance coverage, however, does not necessarily equate to access. This holds especially true for low-income, public insurance such as Medicaid as fewer providers accept this insurance. Colorectal cancer (CRC) screening is important for detecting precancerous colonic lesions and preventing progression to future disease. This study compares the rate of CRC screening in appropriately aged individuals on public insurance and in their privately insured counterparts.

Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous health survey. The exposition was hosted at a community center in an urban location with a historically African American predominant population. The survey included questions on demographic information, insurance information, access to primary care, and CRC screening. Data from the survey was analyzed in a Microsoft Excel database. Insurance types were classified as public insurance (Medicaid and other District government sponsored programs) or private insurance (Blue Cross, Aetna, etc.). Surveys were excluded if specific questions of interest were left unanswered. Statistical analysis was performed using Fisher’s exact test, with significance set at P<0.05. The study was approved by the university’s institutional review board.

Results: There were 102 participants with an average age of 42.4. Ninety-three (91.2%) identified as African American. Fifty-six (54.9%) respondents had public insurance and 28 (27.4%) had private insurance. Twenty-nine (51.8%) of those with public insurance enrolled within the past 18 months, 25 (44.6%) enrolled earlier, and 2 participants did not respond. Given the predominantly African American population and the recent CRC screening recommendations advising this population to begin screening at age 45, a subgroup analysis was conducted in survey participants 45 years and older. Of the thirty-nine participants 45 years-old and above, 22 (56.4%) had public insurance and 17 (43.6%) had private insurance. Thirteen (59%) publically insured responders received CRC screening while 12 (70.5%) responders on private insurance had received CRC screening (p=0.518).

Conclusions: This study showed that public insurance was not associated with significantly decreased rates of CRC screening when compared with respondents with private insurance. In this study at a Washington, D.C. health expo, a majority of respondents with public insurance had acquired it in the previous 18 months, correlating temporally with ACA Medicaid expansion. While there has been concern that, despite having insurance, public insureds may have difficulty accessing health care, this did not appear to be a barrier to CRC screening in this population. Limitations of our study include a small sample size and a predominantly African American population. Additionally, the District of Columbia had, prior to Medicaid expansion, a greater-than-typical safety net insurance program, so referral patterns and provider acceptance may already have been established.