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Stanford University School of Medicine

Cancer survival disparities show that MediCal is a “disaster” in need of reform, researcher writes

Californians with public insurance, like Medicaid, or no insurance, have lower survival rates for several types of cancer than those with private insurance, according to a new study appearing in JAMA Oncology. More troubling: The size of these disparities -- particularly for patients with prostate, lung or colorectal cancer -- may be growing over time.

That's unacceptable, writes Stanford oncologist Douglas Blayney, MD, in an associated commentary.

"Medicaid in California (MediCal) is neither safe nor effective. If MediCal were a drug, a responsible regulator should consider pulling it from the market," Blayney, who spent much of his career in private practice, writes. The new study, "Trends in Cancer Survival by Health Insurance Status in California from 1997 to 2014," demonstrates that MediCal is a "disaster for Californians," he concludes.

In an email, Blayney explained why he chose to use such strong language. "There is an opportunity to change for the better the cancer detection and treatment system for the one-third of Californians who now have Medicaid as their medical insurance coverage."

Disparities shouldn't be growing -- we know how to do better, he says. For example, Blayney recently paired up with Arnold Milstein, MD, director of Stanford's Clinical Excellence Research Center, to identify practices that provide high-quality, and cost-efficient cancer care. Several features, such as early use of palliative care and availability of an outpatient center, could be expanded more broadly to boost the overall value and quality of cancer care, they conclude.

Blayney said he is hopeful that change is possible:

The California Cancer Registry [which provided data for the original study] is a carefully curated source of cancer outcome data, to which many patients and physicians in California contribute. Our contributions, and the analysis of our Stanford colleagues, should be used to improve cancer outcomes to benefit all Californians.

Stanford authors of the original research study include David Spiegel, MD, and gastroenterologist Uri Ladabaum, MD. Blayney told me that he notified the journal that he shares some patients with Spiegel and Ladabaum, but since he didn't participate in the research, there was no potential conflict of interest.

California is Blayney's home state and he's a big fan. But, he writes:

I am not proud of our MediCal program.


My state, and others, should innovate and test care models, akin to other experiments in the laboratories of democracy. Individual Medicaid programs should provide high-quality, high-value, innovative, safe, and effective care. Policy makers, take note.

Previously: High-value oncology practices include "support for the patient journey"Discussing disparities in care for the most vulnerable infants and Study identifies socioeconomic and ethnic disparities for gallstone surgery
Image by GDJ

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