Health + Behavior

How California can break down barriers to breast cancer treatment

UCLA fact sheets recommend changes to help patients and survivors – particularly low-income women – who face serious obstacles to care

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To help women work through the health care bureaucracy and find the health services they need, the study recommends that women have access to “patient navigators.”

More than 29,000 women in California will be diagnosed with breast cancer in 2018. Many of them — especially low-income women, who suffer the worst survival rates — will face economic, emotional and structural obstacles to getting treatment and follow-up care.

“Breast cancer is one of the most common diseases, so why is it still so hard for women to get adequate care?” asked Ninez Ponce, associate director of the UCLA Center for Health Policy Research and co-author of a two-year study of breast cancer barriers in California. “Women who face the hardship of illness should not also have to face the additional hardship of not being able to find a doctor, or inadequate health coverage or time limits on treatment.”

New fact sheets based on the previously released study recommend that California policymakers address three main issues that are preventing women from receiving life-saving, life-extending treatment for breast cancer.

1. Limitations to public health care

The study found low-income women covered by Medi-Cal and other public health programs, face the biggest hurdles to getting care. Medi-Cal’s provider networks include fewer cancer doctors: While 60 percent of specialists say they will take new Medi-Cal patients with breast cancer, only 42 percent actually do. The Breast and Cervical Cancer Treatment Program, a program for eligible low-income Californians, also restricts the amount of time doctors can spend treating a breast cancer patient. As a result, low-income women wait longer before a doctor is available and have less time to finish treatment, which reduces the chances for them to overcome the disease.

► Read a Q&A with AJ Scheitler about the fact sheets

The survival rate for women who are eligible for both Medicare and Medi-Cal is 59.4 percent, compared to 80.3 percent for women with private insurance.

“It is unconscionable that a woman’s survival rate is dictated by her type of insurance,” said AJ Scheitler, lead author of the fact sheets. “Giving patients in public programs better access to care, as well as protecting ongoing treatment for all women with breast cancer, will not only save their lives; it will enhance their future quality of life.”

The fact sheet recommends that Medi-Cal improve its payment rates to providers to expand the pool of doctors who treat low-income patients, and that Medi-Cal cover breast cancer treatment for longer than the program’s current limit of 18 months.

2. Lack of “patient navigators”

Many women fighting breast cancer face a daunting task navigating a fragmented health care system. They must see multiple doctors, deal with insurance requirements and restrictions, and need support services they have never used before.  

To help women work through the bureaucracy, and understand and find the health services they need — especially when language or cultural differences are an issue — the study’s authors recommend that women have access to health care advocates, or patient navigators, and that the state or health care providers adopt quality standards for those services.

“A woman battling breast cancer should have one task: Beating the disease,” Scheitler said. “Patients benefit tremendously from having a guide help them through the complexities of multiple doctor appointments and a treatment schedule, as well as connections to organizations that provide wigs or mastectomy bras for women who have undergone treatment.”

3. Lack of continuity of care

Another barrier to care is that women sometimes are unable to continue seeing the doctor they know and trust. Among the reasons: Rising premiums that force patients to drop health coverage, a job switch that leads to a change in insurers, or a doctor being dropped from a list of approved providers. Although women with private coverage who are undergoing treatment can usually keep their doctors after a change in insurers, many women are unaware of this protection and have gaps in care while they seek a new provider.

The authors recommend that patients be allowed to continue seeing their doctors until treatment is completed, regardless of insurance status changes; and they call for health providers and insurers to be required to inform patients of their rights if their insurance status changes.

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