Comparative Effectiveness of Health Insurance Reform on Cancer Disparities

描述(由申请人提供)： 本申请涉及广泛的挑战领域(05)比较有效性研究和具体挑战主题05-MD-101*，健康的社会决定因素。我们建议进行比较效果分析和成本效果分析，以调查医疗保险改革在解决癌症健康差距方面的好处。已经描述了癌症健康差异的社会决定因素，其中包括获得高质量医疗保健的机会，以及为高质量医疗支付费用的保险。有必要调查公共卫生政策的相对有效性，这些公共卫生政策通过改善医疗保险，作为克服癌症健康差距的社会决定因素的一种机制，改善获得医疗保健的机会和质量。具体地说，我们建议调查2006年在马萨诸塞州联邦实施的医疗保险改革对那些进行异常宫颈癌和乳腺癌筛查的传统上服务不足的妇女的癌症结局的比较和成本效益。我们建议使用我们的研究小组收集的独特数据库进行此分析，该数据库是波士顿大学患者导航研究计划的一部分。我们收集了超过3300名女性的详细临床、人口统计学、保险和结果数据，这些数据涵盖了波士顿6个社区卫生中心2004-5至2007-9年间接受异常乳腺癌和宫颈癌筛查的全部女性队列。我们建议的研究在其方法和解决该方法的数据集方面都是独特的。我们收集了医疗保险改革特别寻求支持的一组完整的女性临床队列的数据。这个数据集能够观察到马萨诸塞州医疗保险改革的自然实验的结果，因为我们在保险改革之前2年开始收集数据，并在保险改革实施后2年继续收集数据。由于许多人指望马萨诸塞州的经验来制定全国健康保险计划，我们的研究对国家政策具有重大影响潜力。迫切需要有关医疗保险改革的临床影响的经验数据。我们的结果将提供来自经验的比较有效性数据，这对于寻求评估保险改革好处的地方和国家政策制定者来说是至关重要的。我们建议调查2006年在马萨诸塞州实施的医疗保险改革对那些进行异常宫颈癌和乳腺癌筛查的传统上服务不足的妇女的癌症结局的比较和成本效益。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic 05-MD-101*, Social Determinants of Health. We propose to conduct a comparative effectiveness analysis and cost effectiveness analysis to investigate the benefit of health insurance reform on addressing cancer health disparities. The social determinants of cancer health disparities have been described, which include access to quality health care, and insurance to pay for quality care. There is a need to investigate the comparative effectiveness of public health policies that improve access and quality of health care through improvements in health insurance as a mechanism to overcome social determinants of cancer health disparities. Specifically, we propose to investigate the comparative and cost effectiveness of health insurance reform that was instituted in 2006 in the Commonwealth of Massachusetts, on the cancer outcomes of traditionally underserved women who have abnormal cervical and breast cancer screening studies. We propose to conduct this analysis using a unique database our research group has collected as part of the Boston University Patient Navigation Research Program. We have collected detailed clinical, demographic, insurance, and outcome data on over 3300 women, the entire cohort of women with abnormal breast and cervical cancer screening studies between 2004-5 and 2007-9 at 6 community health centers in Boston. Our proposed research is unique both in its approach and in the dataset to address the approach. We have collected data on a complete clinical cohort of women that health insurance reform specifically seeks to support. This dataset has the ability to observe the findings of the "natural experiment" of Massachusetts Health Insurance Reform, in that we began our data collection 2 years prior to insurance reform, and continued 2 years after its implementation. As many look to the Massachusetts experience to develop a national health insurance plan, our research has major impact potential on national policy. There is a critical need for empiric data on the clinical impact of health insurance reform. Our results will provide empirically derived comparative effectiveness data that is of critical interest to policy makers locally and nationally seeking to assess the benefits of insurance reform. We propose to investigate the comparative and cost effectiveness of health insurance reform that was instituted in 2006 in the Commonwealth of Massachusetts, on the cancer outcomes of traditionally underserved women who have abnormal cervical and breast cancer screening studies.