To evaluate the effect of transitioning from a prostate cancer-specific treatment program to comprehensive insurance under the Affordable Care Act (ACA) on the physical, mental, and prostate cancer-related health of poor, previously uninsured men.
We assessed general and prostate cancer-specific health-related quality of life (QOL) using the RAND 12-item short form health survey and UCLA Prostate Cancer Index at 3 time points in 24 men transitioning to comprehensive insurance (insured group) relative to 39 men remaining in the prostate cancer program (control group). We used mixed effects models, controlling for treatment and patient factors, to measure health differences between the groups over the transition period.
Demographics, prostate cancer treatment patterns, and mental, physical, and general health were similar pre-transition between control and insured groups. Post-transition, men who gained insurance coverage reported significantly worse physical health compared to men remaining in the prostate cancer program (p=0.0038). After adjustment in the mixed effects model, physical health remained worse in men who gained insurance (p=0.0036). Mental health and prostate cancer-related QOL did not differ over time between the groups.
Compared to controls who remained in the state-funded prostate cancer treatment program for poor, uninsured men, newly insured men reported worse physical health after transitioning to ACA coverage. Providers and policy makers may draw important lessons from understanding the mechanisms of this paradoxical worsening in physical health after gaining insurance. These results inform the development of disease-specific models of care within the broader health insurance context.
The Journal of urology. 2018 Feb 06 [Epub ahead of print]
Jamal A Nabhani, Ruby Kuang, Hui Liu, Lorna Kwan, Mark S Litwin
UCLA/VA National Clinicians Scholar Program, Los Angeles, CA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: ., David Geffen School of Medicine at UCLA, Los Angeles, CA., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA Fielding School of Public Health, Los Angeles, CA.