Kwon, Youngmin
(2024)
The Role of Public Programs for Early Cancer Detection and Access to Care Among Cancer Survivors.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Medicare and Medicaid play a critical role in providing health insurance coverage to the large population of patients who are diagnosed with cancer. Medicare is the largest payer of health services for cancer patients and survivors, most of whom are aged 65 or older. Medicaid is a growing source of coverage for younger adults with low income or disabilities, who historically have faced adverse cancer outcomes. Considering the rising incidence and burden of cancer, rigorous policy analysis to inform effective cancer prevention and control in Medicare and Medicaid is crucial.
This dissertation investigates elements of the Medicare and Medicaid programs in the context of cancer prevention and control. In Aim 1, I examine eligibility for Medicare at age 65 and its implications for older cancer survivors' access to and ability to afford care. Using a regression discontinuity design, I find that Medicare eligibility is associated with significant reductions in, but not elimination of, cost-related barriers to care. Aim 2 assesses the impact of Medicaid managed care on early cancer detection. I exploit the expansion of mandatory managed care in Pennsylvania Medicaid as a natural experiment and find that this expansion was associated with improvements in early detection. In Aim 3, I evaluate disparities in cancer screening associated with experiences of homelessness and housing insecurity, an increasing focus of Medicaid programs seeking to address nonmedical determinants of health. Using a novel linkage of Pennsylvania's administrative Medicaid and housing services records, I find that women adult Medicaid beneficiaries experiencing or at risk of homelessness are significantly less likely to receive guideline-recommended mammograms.
These results point to several avenues for reforming Medicare and Medicaid for effective cancer prevention and control. Aim 1 findings suggest that expanding eligibility and cost protection within Medicare can lessen the financial burden of care among older cancer survivors. Aim 2 illustrates the potential for managed care to address the high incidence of advanced-stage cancer, a key driver of adverse outcomes in Medicaid. Aim 3 demonstrates that optimal cancer prevention will require greater efforts among public programs to address vulnerability linked to housing insecurity and other health-related social needs.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
26 June 2024 |
| Date Type: |
Publication |
| Defense Date: |
25 April 2024 |
| Approval Date: |
26 June 2024 |
| Submission Date: |
21 June 2024 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
194 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Health Policy & Management |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Medicaid, Medicare, Cancer Prevention and Control, Access to Care, Quasi-experimental Methods, Health Services Research |
| Date Deposited: |
27 Jun 2024 00:34 |
| Last Modified: |
27 Jun 2024 00:34 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46607 |
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