Disparities in Cancer Stage at Diagnosis, Quality of Care, and Outcomes Associated With Different Sources of Health Insurance in California

I commend to you a great and difficult read in this recent study from a group at UC Davis. We have a bigger data set here, though still not all-payer data, confirming that California has poorer survival and higher proportions of late state at diagnosis among Medicaid recipients across several cancer types.

Some of the little pieces of sub-data are just fascinating. For example, those insured by the DOD seem to incur the longest wait time between diagnosis and the start of treatment, though that group's outcomes are still superior to outcomes from some insureds diagnosed sooner but given lower quality care.  

Careful not to draw any conclusions about why, the study concludes that Medi-Cal beneficiaries fare no better than California's uninsured for certain kinds of cancer care.  Does this mean Medi-Cal funding on cancer care is for nought? Or, does it mean any of a number of other things: that Medi-Cal beneficiaries are relatively late diagnosed with certain kinds of cancer because of access problems? Or, is the lower quality care because the Medi-Cal reimbursement accepting oncology universe is less likely to follow current treatment protocols? Or, is it something else? 

There are so many questions to ask the data, I can only hope Ken Kizer et al mean this as a first paper in a series. You see, we have a number of studies like this but few that drill down to ask the subsidiary questions, however even more uncomfortable they might make us.