How Health Insurance Affects FL Survival

The Blood journal has published a study that shows that Follicular Lymphoma patients with private health insurance have a better survival rate than patients on public insurance, or no insurance.

The study looked at 43,648 FL patients who were diagnosed between 2004 and 2014. Researchers looked at two groups -- patients under 65 and patients over 65.

Some quick background, especially for those of you who don't live in the United States.

Unlike countries like Canada and Great Britain, health insurance in the U.S. is paid for a few different ways. Most people with health insurance have private insurance, paid for by the individual, usually offered through an employer, who pays for some of the cost.

However, there are some people who have government-subsidized health insurance. People over 65 may be eligible for Medicare, which is funded by payroll taxes (when we are working, we pay into the system so we can have the insurance later in life). Medicare is also eligible to some young people with certain health problems.

Others get health insurance through Medicaid. This program is run by federal and state governments, and provides healthcare for people with lower incomes, whatever their age.

Medicare and Medicaid are more complicated than that, but that's a pretty basic breakdown.

And, of course, there are people with no health insurance at all, because they can't afford it, aren't eligible for it, or just choose not to get it.

In the study, 47% of patients had private insurance, 3% had no insurance, 4% had Medicaid, and 46% of patients had Medicare. 

As for the results of the study, the researchers found that, for patients under 65, the 5 year Overall Survival for patients with private insurance was 90%. For patients with Medicare, it was 78%. With Medicaid, 80%, and with no insurance, 78%. The low number for patients with Medicare is probably influenced by other health issues -- people on Medicare who are under 65 usually are eligible for it because of other health problems.

For patients over 65, the Overall Survival at 5 years was 69% for those with private insurance and 62% for those with Medicare.

So in both age groups, FL patients with private insurance had significantly better outcomes than those without it, no matter how they paid for their health care.

There are a lot of questions that could be asked about the groups, and the researchers do point them out. With such a large study, it's not really possible to get as much information as they would have liked. The patient records were taken from the National Cancer Database, so they do have information about their insurance and the treatments they got. But they don't have information about some other factors that might have affected their health.

Now, as with any study like this, it's important to remember that it doesn't say anything about us as individual patients. Having one type of insurance or another will not predict our own survival.

But it does say something about the state of healthcare in the United States. It's still unsettled. Some people have access to private insurance (and the apparent benefits of that insurance) and some don't. Some people like the changes that have come about with the Affordable Care Act (which really came into full force in 2014, at the end of the period being looked at it in this study). Some people don't like those changes. Some want a system with a single payer (like Canada's or Great Britain's), and some don't.

I think I'll agree with the researchers, who say that studies like this, that look backwards, aren't enough. We need to start collecting information now about patients, their insurance status, their socioeconomic status, their genetics, and other information, and use that to help shape public policy -- the laws that decide how people get healthcare.

That won't be easy. But it's probably the best way to make sure that politics isn't the thing that decides our healthcare.