all health status of the community and its health care institutions and providers, and the access of its residents to certain services. These are among the conclusions reached by the Institute of Medicine’s (IOM’s) Committee on the Consequences of Uninsurance in their 2004 report, Insuring America’s Health: Principles and Recommendations (IOM, 2004a).
Many studies link lack of health insurance with poor cancer outcomes (Ayanian et al., 1993; Lee-Feldstein et al., 2000; Ferrante et al., 2000; Roetzheim et al., 2000a,b; Penson et al., 2001; IOM, 2001, 2002a). Access to health insurance has been found to influence the amount and quality of health care received, which in turn is likely related to survival. Three-year relative cancer survival was markedly poorer for those without health insurance as compared to the insured, according to one state’s population-based study (Grann and Jacobson, 2003; McDavid et al., 2003). The link between insurance status and health outcomes is complex and confounded by socioeconomic status, race and ethnicity, and other factors. In one study, non-elderly cancer patients without insurance were found to be at risk for receiving inadequate cancer care, especially if they were Hispanic (Thorpe and Howard, 2003). Here, expenditures for uninsured patients under age 65 were nearly half (57 percent) that of privately insured patients over a 6-month period. Spending differences were believed to be due, in part or