Health Care Reform Through the Cancer

Lens State and Private Sector Reforms for

Hispanic Healthcare

Edward E. Partridge, MD National Board President American Cancer Society

National Hispanic Medical Association 15th Annual Conference

March 19, 2011

Through its Body of Work, the American Cancer Society is the

leader in the global effort to eliminate cancer disparities

among ALL populations …Because Cancer Doesn’t Discriminate!

The Case For Equity

Population Distribution by Race/Ethnicity, U.S. (2009)

White

Black

Hispanic

Other

0% 10% 20% 30% 40% 50% 60% 70%

65%

12%

16%

7%

Source: U.S. Census Bureau, CPS: Annual Social and Economic Supplements

Uninsured Hispanic, under age 65: US, 1998-2009

(3 Year Annual Average)

Source: National Health Interview Survey (NHIS)

Leading Causes of Death, Among Hispanics by underlying cause, ages 18+:

US/State, 1999-2007

Source: The National Vital Statistics System

Death Rates

Chronic conditions, ages 18+: US, 1997-2008 - Hispanic Population

Source: National Health Interview Survey (NHIS)

Per

cent

%

%

%

%

%

%

% %

%

%

%

%

Incidence and Death Rates for All Cancers Combined among Hispanics 1992-2006

Source: Cancer Facts & Figures for Hispanics/Latinos, American Cancer Society, Atlanta, GA

What We Know

Suffering and death could be prevented through more systematic methods of health screening and early detection.

A disproportionate number of Hispanics and other medically underserved populations are not fully benefiting from available resources.

Underlying causes of cancer disparities are interrelated and complex

Causes of Cancer Disparities

Can be linked to social determinants of health, such as but not limited to:

Inequalities in access to care, Language barriers, Unhealthy environments, and Discrimination

Disparities In Outcomes Are Related With:

1. Treatment… Hispanics and other minority groups are more likely to be living in poverty

and are less likely to receive recommended treatment.

2. Screening… Hispanics and other minority groups are more likely to be uninsured and are

less likely to receive timely screening.

3. Incidence… Hispanics and other minority groups are more likely to be diagnosed with

later-stage preventable cancers.

4. Mortality… Hispanics and other minority groups are more likely to earn a lower income

and are more likely to die from preventable cancers.

5. Risk Factors… Hispanics and other minority groups are more likely to report cancer related

risk factors.

Focus Areas: Prevention and Early Detection - increasing access to cancer screening, diagnosis and treatment Information – data collection and evaluation Quality of Life - Serving with impact Research

Through…

Advocacy System Policy and Practice Cancer Information and Empowerment Resource Navigation Communities of Support Research

How Do We Address Disparities?

Lessons Learned

Task of Eliminating Disparities – Daunting or not?

1. Technical advances to be delivered not so complex -- tobacco control

-- age appropriate screening -- healthy diet, physical activity

2. Populations most at risk -- geographically focused

3. Patient Protection and Affordable Care Act -- eliminates barrier to access

4. Communities most at risk eager to engage

Easy to More Difficult Changes

Easy 1. age appropriate screening

2. tobacco control

3. high quality treatment for all

Difficult 4. healthy eating, physical activity

Community Engagement

Create trust

Eliminate bias

Share power

Strategies to Improve Cancer screening among Hispanics

Effective communication initiatives are needed to close this knowledge gap.

Social support may improve participation in screening.

Local outreach programs and culturally targeted interventions by lay Hispanic health advisors along with physician encouragement are also effective strategies for improving cancer screening participation rates

A number of provisions in the Affordable Care Act will help reduce these disparities and increase access to culturally

competent care for Hispanics

How Does the Patient Protection and Affordable Care Act Help?

Expanding Coverage Private insurance Medicaid Medicare

Enhancing Prevention

Improving Quality of Life

ImplementationExpanding Coverage: Medicaid

Expands coverage to all persons under 133% FPL (up to $29,327 for a family of four)

Simplifies enrollment into Medicaid

Incentive programs to encourage participation in chronic disease preventive programs

Increases access to cessation drugs

Implementation Addressing Disparities

Qualified health plans must provide materials in appropriate languages

Strategy for increased access to language translation services

Implementation: State activity

Contracting of high-risk pools

Creation of the exchanges

Creation of state-based ombudsman programs

Protecting mandates and Breast and Cervical program until at least 2014

YOUR ROLE

Implementation: To do list

Learn what’s in the bill

Identify state publications that will update you

Develop a relationship with your State and Local officials, i.e. State Insurance Commissioner and Medicaid Director

Implementation: Resources

ACS CAN Web page: http://www.acscan.org/

©2010 American Cancer Society, Inc. No.0052.19

THANK YOU