THE EFFECTS OF BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT (BCCPTA) IN GEORGIA Pubblico
Chien, Li-Nien (2010)
Abstract
The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000 allowed states to extend Medicaid coverage to uninsured women under 65, diagnosed with breast and cervical cancers (including pre-cervical condition) through the National Breast and Cervical Cancer Early Detection Program providers, or in Georgia any provider, and found in need of cancer treatment.
The first article examined whether BCCPTA helped uninsured breast
cancer patients enroll in Medicaid more quickly to start treatment
at early stage. I conducted a quasi-experimental study that
compared the stage of cancer of the women aged 19-64 diagnosed with
breast cancer who were eligible for BCCPTA with those in the same
age spectrum diagnosed with one of five other cancers when they
enrol ed in Medicaid. The marginal effect of BCCPTA increased 9.5%
breast cancer cases enrolling in Medicaid at early stage
(p<.1).
The second article examined how BCCPTA affected the patterns of
disenrollment from Medicaid for women diagnosed with breast,
cervical and control cancers. The post-BCCPTA period analyzed here
was one in which Georgia women could self-report that they
were in active treatment and hence, stil eligible. The unadjusted
disenrollment rate declined 50% for breast and cervical cancer
cases while it increased 30% for control cancer cases post-BCCPTA.
The direction and magnitude of results held after adjusting for
covariates that could affect disenrol ment rates.
The third article investigated cervical cancer treatment of
patients enrolled in Medicaid under BCCPTA. Of patients with
pre-cervical condition, 56% received a cancer 'work-up' while this
applied to 85% of those with an invasive condition. In terms
of
treatment combination, 75% of pre-invasive patients had a
precancerous procedure, with about 21%, versus 34 % of invasive
cases receiving surgery. Those more likely to receive surgery among
pre-invasive cases were those with more advanced stage and a
co-morbidity. Among invasive cases, later stage was associated with
higher odds of radiation/chemo but not surgery. Non-Hispanic black
were significantly less likely to have surgery than those
no-Hispanic white in both pre-invasive (p < .01) and invasive
cases (p = .05).
Table of Contents
Table of Contents
CHAPTER 1 . 1
The Background and the Implementation of Breast and Cervical Cancer Prevention and Treatment Act .. 1
1.1 Background .. 1
1.2 Implementation .. 3
1.3 Objective . 7
References . 9
Chapter 2 . 11
The Effects of the Breast and Cervical Prevention and Treatment Act on Early Stage at Medicaid Enrollment: Experience from Georgia .. 11
Abstract . 11
2.1 Introduction .. 13
2.2 Methods . 16
2.3 Results . 21
2.4 Limitation .. 23
2.5 Discussion .. 25
References . 27
Chapter 3 . 34
The EffectS of the Breast and Cervical Cancer Prevention and Treatment Act on Medicaid Disenrollment .. 34
Abstract . 34
3.1 Introduction .. 36
3.2 Methods . 39
3.3 Results . 42
3.4 Limitation .. 44
3.5 Discussion .. 46
References . 49
CHAPTER 4 . 55
Cervical Cancer Treatment of Patients Enrolled Under the Breast and Cervical Cancer Prevention and Treatment Act in Georgia .. 55
Abstract . 55
4.1 Introduction .. 57
4.2 Methods . 59
4.3 Results . 64
3.4 Limitation .. 66
4.5 Discussion .. 67
References . 72
CHAPTER 5 . 86
Conclusion and further Research .. 86
5.1 Conclusion .. 86
5.2 Further research 87
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