Wayne State University

WSU/KCI review of breast and cervical cancer screening program highlights need to address economic challenges of uncompensated care

DETROIT—With approximately 44 million Americans uninsured, health care systems and providers bear much of the financial burden by providing unreimbursed services.
            The absence of health insurance is a major impediment to receiving preventative health care as well as other health care needs extending beyond prevention. According to a study done at Wayne State University’s School of Medicine, the Karmanos Cancer Institute and Henry Ford Health System, the success of targeted programs in addressing some of these preventive needs may nevertheless leave other health care needs unaddressed. Little is known about the magnitude of the additional costs that might be incurred by participating health systems – this study aimed to begin to comprehend this growing problem.  
            To better understand the potential financial impact health systems endure, Robert Burack, M.D., professor of internal medicine at Wayne State University and the Karmanos Cancer Institute, and Elston Lafata, M.D., of the Center for Health Services Research at Henry Ford Health System, have published an analysis in the recent issue of the Journal of Health Care for the Poor and Underserved.  It focuses on the cost of health care services provided to women enrolled in a community-based breast and cervical screening program.
            The Wayne County Breast and Cervical Cancer Control Program provides breast and cervical cancer screening, follow-up and treatment services for uninsured and underinsured low-income women ages 40 to 64.  Developed and funded through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Michigan Department of Community Health, the program is designed to provide only breast and cervical services and thus other types of care are not reimbursed through the program.  All clinical services are delivered by participating health care organizations who determine which, if any, additional services to provide to program enrollees. The study found that nearly 50 percent of the total cost of care provided to those enrolled in this program was uncompensated, with about 15 percent being paid for by the Breast and Cervical Program and the remainder from other sources.
            The NBCCDEP has benefited tens of thousands of women each year. As successful as the program has been in accomplishing its breast and cervical cancer control objectives, it was not designed to meet other health care needs of enrollees. Those health care providers who choose to participate are then faced with the challenge of determining whether and how to address these needs.
            “This program’s success in providing access to health care for underserved women highlights the economic challenges of uncompensated care already faced by health care providers serving disadvantaged communities,” said Burack. “Until the larger issue of no or inadequate health insurance is addressed, the unmet health care needs of the uninsured will grow, while the capacity of already challenged safety net providers to meet this need will decline.” 
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Wayne State University WSU is one of the nation’s pre-eminent public research universities in an urban setting, ranking in the top 50 in R & D expenditures of all public universities by the National Science Foundation. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. To learn more about research at Wayne State University, visit http://www.research.wayne.edu.
Barbara Ann Karmanos Cancer Center Located in mid-town Detroit, MI, the Barbara Ann Karmanos Cancer Center is one of 40 National Cancer Institute-designated comprehensive cancer centers in the United States. Caring for nearly 6,000 new patients annually on a budget of $216 million, conducting more than 700 cancer-specific scientific investigation programs and clinical trials, Karmanos is among the nation’s best cancer centers. Through the commitment of 1,000 staff, including nearly 300 faculty members, and supported by thousands of volunteer and financial donors, Karmanos strives to prevent, detect and eradicate all forms of cancer. For more information call 1-800-KARMANOS or go to www.karmanos.org.