Table 5.

Health insurance coverage disruptions and other health services use and health-care spending^a

Reference	Sample size, No.	Setting, data source, and year	Insurance coverage measures	Outcome measures	Key findings
Koroukian et al., 2006 (36)	44 509 decedents with cancer as underlying cause of death (no age restriction)	Ohio Medicaid Enrollment and claims data: death certificate, 1992-2002	Duration of coverage measured as Medicaid enrollment months prior death (enrolled at month of death, or 1-3, 4-6, 7-9, 10-12, or >12 mo prior death)	Per person per month enrolled total medical expenditures from claims	2.5%, 12.7%, 7.8%, 5.3%, 4.7%, and 67.0% of decedents enrolled in Medicaid at month of death, 1-3, 4-6, 7-9, 10-12, or >12 mo prior death, respectively. Overall, longer time of Medicaid enrollment was associated with higher monthly total expenditures. Monthly expenditures were $770, $1105, $1674, $1941, $1987, and $1905 for those enrolled at month of death, 1-3, 4-6, 7-9, 10-12, or >12 mo before death, respectively. Year of dollars not stated
Mack et al., 2013 (54)	4797 California patients and 4001 New York patients aged 21-64 y with newly diagnosed stage IV lung cancer	California and New York State Cancer Registry - California and New York Medicaid Enrollment, 2002-2006. Follow-up through 2017	Medicaid enrollment between month of diagnosis and month of death or censoring (continuous, enrolled more than 50% of the time but not continuously, enrolled <50% of time)	Hospice use from claims	69%, 21%, and 10% patients continuously enrolled in Medicaid, enrolled >50% of time but not continuously, enrolled <50% of time in California, respectively; 64%, 24%, and 12% patients continuously enrolled in Medicaid, enrolled >50% of time but not continuously, enrolled <50% of time in New York, respectively. In both states, compared with continuously enrolled, patients enrolled >50% of time but not continuously (OR = 0.82, 95% CI = 0.69 to 0.98) or enrolled <50% of time (OR = 0.45, 95% CI = 0.35 to 0.57) had lower hospice use
Mack et al., 2015 (55)	705 decedents previously diagnosed with cancer between ages of 15 and 29 y	New York State Cancer Registry - Medicaid Enrollment, 2004-2011. Deaths by Dec. 31, 2011	Timing of coverage measured as 1) enrolled in Medicaid before diagnosis or around time of diagnosis (duration of enrollment before diagnosis not stated); 2) Medicaid enrollment between month of diagnosis and month of death (continuous, enrolled >50% of the time but not continuously, enrolled <50% of time)	1) Hospice use; 2) EOL intensity measured by chemotherapy use within 14 d of death, care in ICU within 30 d of death, more than 1 ER visit within 30 d of death, hospitalization within 30 d of death from claims	15.4% of patients enrolled in Medicaid at or after cancer diagnosis. 65.5%, 28.5%, and 6.0% patients continuously enrolled in Medicaid, enrolled >50% of time but not continuously, enrolled <50% of time, respectively. Compared with patients enrolled before cancer diagnosis, those enrolled at or after diagnosis had lower hospice use (OR = 0.26, 95% CI = 0.08 to 0.83). Compared with continuously enrolled, patients who enrolled >50% of time but not continuously (OR = 0.36, 95% CI = 0.23 to 0.56) or enrolled <50% of time (OR = 0.22, 95% CI = 0.10 to 0.51) were less likely to have intensive EOL care

^aCI = confidence interval; EOL = end-of-life; ER = emergency room; ICU = intensive care unit; OR = odds ratio.