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THE EFFECTS OF BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT (BCCPTA) IN GEORGIA

Chien, Li-Nien (2010)
Dissertation
Committee Chair / Thesis Adviser: Adams, Kathleen
Committee Members: Lipscomb, Joseph ; Yang, Zhou ; Howard, David H
Research Fields: Health Sciences, Public Health
Keywords: BCCPTA; Medicaid; breast; cervical
Program: Laney Graduate School, Health Services and Research Health Policy
Permanent url: http://pid.emory.edu/ark:/25593/850c4

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).




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