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ACS researchers offer solutions to reduce health disparities in rural America

​Highlight critical role of adequate health insurance coverage

An editorial about rural cancer disparities by members of our Surveillance and Health Services Research team was published June 24 in JCO Oncology Practice, an American Society of Clinical Oncology Journal.

“Rural Cancer Disparities in the United States: A Multilevel Framework to Improve Access to Care and Patient Outcomes” lays out the disparities suffered by rural residents. Because of the central role of health insurance coverage in ensuring access to cancer screening, diagnosis, and treatment, they highlight solutions related to expansion of health insurance coverage options as part of the Affordable Care Act, including expansion of Medicaid eligibility for adults with and without children. The authors note that after Medicaid expansion in 2014, rural-urban disparities in insurance coverage among newly diagnosed cancer patients age 18 to 64 years were eliminated in Medicaid expansion states, but remained  in nonexpansion states.

In addition, there is currently no national policy requiring state Medicaid programs to cover routine care for clinical trial participants. Lack of coverage is thought to be associated with lower clinical trial participation among Medicaid enrollees in states that do not cover routine care costs.

“Reducing rural cancer disparities will require multilevel interventions, with coordinated efforts at the patient, provider, community, and policy levels. Scientists have been highlighting the need for multilevel approaches to address persistent health disparities for many years,” the researchers wrote.

“Increasing insurance coverage options for rural adults through Medicaid expansion and availability of other coverage options, improving local provider coordination with cancer centers, and creating shared resources and expertise through networks such as the National Cancer Institute Community Oncology Research Program and telemedicine, and developing broader community-based resources to support and promote healthy lifestyles may improve access to cancer prevention, screening, diagnosis, and treatment. Coupled with Medicaid coverage of routine care costs for clinical trial participation and travel for care in all states, these efforts may increase trial participation among rural residents and reduce rural cancer disparities.”

Read the full editorial. Its authors are Robin Yabroff, PhD; Xuesong Han, PhD; Jingxuan Zhao, MPH; Leticia Nogueira, PhD, MPH; and Ahmedin Jemal, DVM, PhD.

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