Influence of insurance status on patterns of care-seeking among colorectal cancer patients

Background: Colorectal cancer (CRC), a leading cause of cancer death in the U.S., can be treated successfully when detected early. Yet many eligible individuals remain unscreened. Health insurance status predicts health service use. To evaluate the role of health insurance status on obtaining a diagnosis of CRC, we analyzed interview transcripts from patients reporting financial barriers in obtaining medical care for CRC symptoms. Methods: Semi-structured interviews were completed with newly diagnosed CRC patients in Virginia and Ohio. Interviews focused on symptom recognition, access to care, communication with physicians, and socio-demographics. These results are from 86 patients who experienced financial barriers to obtaining care. Themes were identified through iterative analysis of verbatim transcripts. Results: Three groups of patients discussing financial barriers were identified: uninsured (47%), insured (24%) and intermittently insured (29%). Themes identified were, Changing Insurance Coverage (identified by 29% of patients), Financial Ramifications (36%), Self Advocating For Care (30%), and Physician Involvement in Overcoming Barriers (14%). Insured patients were concerned about co-payments, deductibles and felt insurance companies were barriers to obtaining care. Uninsured patients worried about medical bills and used the emergency room to seek care. Intermittently insured patients were also concerned about medical bills but engaged physicians in discussions about payment options. Conclusions: Dichotomized categorizations of insured or uninsured patients do not capture the nuanced differences in barriers faced by individuals seeking access to medical care. Ameliorating financial barriers to medical care may require different interventions depending on the insurance status and primary concerns of different patient groups.