Men in minorities or treated under Medicaid receive lower quality care

In yet another utterly unsurprising “research” finding, a new article in the Journal of Urology has shown that — in the USA — minority prostate cancer patients and prostate cancer patients treated under Medicaid are less likely to have their prostates removed at high-experience and high-volume hospitals where there is high use of robot-assisted surgical techniques.

The details related to this paper by Kim et al. can be found in the abstract and in a related article on the Reuters web site.

Basically, the poor and the less privileged (by whatever means you choose to assess such social factors) are less likely to receive high quality care at high volume hospitals than the well-insured majority. It’s the way the American healthcare system is designed to work — for better or for worse!

We should emphasize that this article is not suggesting that robot-assisted laparoscopic surgery (RALP) is technically superior compared to open or non-robot-assisted laparoscopy. To quote Dr. Michael Barry, “The issue here is not access to [robotic surgery] but high-volume hospitals.” Dr. Barry, who was not a member of the study team, is a clinical professor of medicine at Harvard Medical School with a high interest in issues affecting the management of prostate cancer.

5 Responses

  1. Do they have problems with the quality of care where radiation/not surgery is the treatment?

  2. Richard:

    I suspect that is extremely likely, regardless of treatment type … but I am not aware of concrete evidence to support that suspicion.

  3. Of course there is an entity, namely the USPSTF, that feels that Medicaid is providing over-treatment to men on Medicaid for surgery and other front line therapies. In many cases where a patient is denied these services it can clearly be argued that it was a good thing and not a bad thing. It’s possible, for the wrong reasons, we see a necessary restraint…

    I am interested in how well Medicaid is handling advanced therapies. It would be speculation to say they are being denied chemotherapy or services associated with administering a clinical trial where drugs are being provided by the manufacturers or sponsors. In addition, many drug companies are providing “compassionate relief” for already released drugs when the patient is indigent and has no financial resources. In these cases there are still administrative costs involved.

    Perhaps you can report on that sometime in the future?

  4. Dear Tony:

    (1) In defense of the USPSTF, I am not aware that they have ever made any specific comment about the treatment of men under Medicaid. USPSTF’s recommendations have been confined to the value of mass, population-based screening, and apply regardless of the type of health care services available to individual patients.

    (2) With regard to reporting on access to treatments for advanced prostate cancer through Medicaid, this varies from state to state since Medicaid is a state-based program, not a national program. As a consequence, it is almost impossible to report on this nationally. We do try to comment when we see any useful information on state-based initiatives, but such data are very rare. The one thing that I can tell you is that, in the current economic environment, Medicaid is not a form of health coverage that I would want to have to rely on personally!

  5. This is B A L O N E Y!!!! I was diagnosed with advanced prostate cancer 7 years ago. About 2 years ago I had to switch to Medicare Coverage (from a great Blue Cross Blue Shield program). My quality of treatment has not changed one iota, and whoever is stating this “carte blanche” is dead wrong!

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