Document Type
Article
Publication Date
1-9-2017
Publication Title
Journal of Primary Care & Community Health
Volume
Advanced access published
Keywords
primary care, supply of physicians, poverty, health insurance, breast cancer, breast cancer care, health care policy, health care reform, Patient Protection and Affordable Care Act, Obamacare
Abstract
Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation therapy. Results: Women in Ontario received more optimal care in communities well supplied by primary care physicians. They were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (rate ratio = 1.65) and communities lacking specialist physicians (rate ratio = 1.33). Canadian advantages were explained by better health insurance coverage and greater primary care access. Conclusions: Policy makers ought to ensure that the newly insured are adequately insured. The Medicaid program should be expanded, as intended, across all 50 states. Strengthening America’s system of primary care will probably be the best way to ensure that the Affordable Care Act’s full benefits are realized.
DOI
10.1177/2150131916686284
Funding Reference Number
The work was supported by a grant from the Canadian Institutes of Health Research (Grant no. 67161-2).
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License
Recommended Citation
Gorey, Kevin M.; Hamm, Caroline; Luginaah, Isaac N.; Zou, Guangyong; and Holowaty, Eric J.. (2017). Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places. Journal of Primary Care & Community Health, Advanced access published.
https://scholar.uwindsor.ca/socialworkpub/55
Included in
Clinical Epidemiology Commons, Community Health and Preventive Medicine Commons, Epidemiology Commons, Geography Commons, Health Policy Commons, Health Services Research Commons, Public Policy Commons, Social Policy Commons, Social Work Commons, Women's Health Commons