ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia

QUESTION ASKED: We sought to determine the likelihood that pediatric and adolescent acute lymphoblastic leukemia (ALL) patients experience a gap in health insurance coverage in the first 2 years of therapy.SUMMARY ANSWER: We found that 12% of patients with ALL in our sample who had insurance at diagnosis experienced a gap in insurance coverage during the first 2 years of therapy; that is, they had one or more clinic encounter at which they did not have insurance. Patients with public insurance at diagnosis were more likely to experience an insurance gap than those with private insurance at diagnosis, and those diagnosed in more recent years were less likely to experience a gap.METHODS/APPROACH: We determined insurance status at all clinic encounters at a tertiary children’s hospital within 2 years of diagnosis for patients diagnosed with ALL between 1998 and 2010, and calculated the odds of a gap occurring on the basis of demographic and diagnostic variables.BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Our assessment is from years before the roll-out of key Patient Protection and Affordable Care Act provisions, which should improve insurance coverage for pediatric and adolescent patients with ALL. In addition, we lacked information on patient or caregiver socioeconomic status, which may be important for explaining insurance gaps. Finally, our assessment is based on a single institution.REAL-LIFE IMPLICATIONS: Gaps in health insurance may exacerbate the financial and emotional burden associated with pediatric and adolescent cancer. Understanding the likelihood that these gaps will occur, as well as predictors of insurance gaps, will allow social workers and other providers to help families manage anticipated changes in insurance, with the goal of reducing unnecessary burden. [Figure: see text]