The availability of health care resources explains some geographic variation in cancer treatment:
Having health insurance and the type of coverage one has are also associated with differential treatment patterns:
Physicians may not recommend expensive chemotherapy for uninsured or underinsured patients for financial reasons or because they believe that such groups are less likely to comply with the treatment regimen (Begg and Carbone, 1983).
In one study, one-third or more patients undergoing treatment for cancer in Texas reported out-of-pocket costs exceeding $100 per visit for chemotherapy or radiotherapy. Hispanics were more likely than whites or blacks to have out-of-pocket costs higher than $200 per visit, probably because they were uninsured or underinsured (Guidry et al., 1998).
These same investigators found that black and Hispanic cancer patients being treated in Texas with chemotherapy or radiotherapy consistently reported that barriers such as distance, access to an automobile, and availability of someone to drive them to the treatment center were major problems (Guidry et al., 1997).
The major barriers influencing whether or not patients with cancer seek or continue treatment identified in a recent review of the literature include (Guidry et al., 1996):
Access barriers generally were found to be greater for older women, members of minority groups, and patients of lower socioeconomic status.