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Caring for Our Uninsured Patients
As fellows, we have all encountered uninsured patients in either the hospital or the clinic setting. Depending on the type of practice where you are training (eg, private vs university, urban vs rural), there will be a different proportion of patients who lack insurance coverage. According to the Kaiser Commission on Medicaid and the Uninsured, in 2009 there were 50 million people in the United States under the age of 65 who lacked health insurance. In many parts of the country, the stereotype of the uninsured homeless patient has been replaced by uninsured working families, who now make up more than three-fourths of the uninsured population. The increase in uninsured patients crosses age and ethnic boundaries and affects their health because they are unable to receive both the preventive and therapeutic care they need. In the case of our patients, the need both emotionally and financially will be high if they have a new diagnosis of cancer.Unfortunately, the number of uninsured patients is increasing at a time when the cost of cancer care continues to rise. According to the National Cancer Institute, in 2006 cancer care accounted for an estimated $104.1 billion in medical care expenditures in the United States. As we develop advanced molecularly targeted therapies, this number continues to rise. To an individual patient, there is variability in the cost of cancer therapy, but when you consider the cost of chemotherapy, surgery, radiation, and supportive medications, it’s easy to reach tens of thousands of dollars per treatment regimen. For all but the wealthiest patients, this becomes cost prohibitive without insurance coverage or another means of financial support.As medical students and residents, we often are able to defer insurance status issues to a team of support staff, such as social workers and case managers. As we transition to attending positions, the issues of insurance coverage become increasingly apparent and important to understand because of the potential interference in our ability to provide excellent care. By understanding the unique challenges of the uninsured and the resources available to them it is—in most cases—possible to provide them with the same excellent care as their insured counterparts.Unique Challenges of the Uninsured