The Impact of Massachusetts Health Reform on Cancer Diagnosis and Treatment.

Co-Principal Investigator:Bassam A. Dahman, Ph.D.

Funding Source: American Cancer Society / University of Pittsburgh


This study will investigate the effect of health reform in the state of Massachusetts, which led to significant increases in the rate of health insurance coverage, on diagnosis and treatment of breast and colorectal cancer. We will compare outcomes for individuals in different areas of Massachusetts based on pre-reform insurance coverage rates. We will also compare Massachusetts cases to cases in other states to further control for any trends not due to reform. Finally, we will explore the association between area-level physician and hospital supply and characteristics and changes in outcomes after reform.


Evaluate and improve access and quality of care for prostate cancer patients

Principal Investigator: Bassam A. Dahman, Ph.D.

Funding source: Hunter Holmes McGuire VA Medical Center


Leads the assessment of the use VINCI in the development and execution of research and operational studies to evaluate and improve access and quality of care for prostate cancer patients. The compliance with therapeutic guidelines, and quality of health outcomes will be evaluated and compared between veterans who receive their cancer treatment at VA facilities to those who are treated by community practices under the CHOICE program.


Disparities in Cancer Screening: The Role of Medicaid Policy

Site Principal Investigator: Bassam A. Dahman, Ph.D.

Funding Source: National Cancer Institute and the Office of Behavioral and Social Science Research / University of Pittsburgh


There are substantial disparities in breast and cervical cancer diagnosis, treatment and outcomes in the U.S. by race, ethnicity, socio-economic and insurance status. While mortality rates have fallen over recent decades due to improved screening and treatment, these benefits are not distributed equally across the population.

Despite the existence of programs aimed at screening underserved women (e.g., the National Breast and Cervical Cancer Early Detection Program), many eligible women are not reached, and research shows that significant disparities in screening remain. Medicaid coverage for low-income women may play an important role in ensuring access to screening, though supporting evidence is limited and does not address recently enacted and proposed changes in patient eligibility, physician payment and patient cost sharing.

Study design

The study examines how existing and new policies that affect the generosity of state Medicaid programs correlate with breast and cervical cancer screening and related health outcomes among low-income women. The study will consider the effect of pre- and post-healthcare reform variation in eligibility between and within states, as well as the effect of physician payment and patient cost sharing on screening. It will also assess how the variation in Medicaid generosity across states and over time is related to outcomes including cancer incidence and stage at diagnosis.

The project brings together complementary secondary data from a number of sources. Nationally representative survey data from the Behavioral Risk Factor Surveillance System will be used to study the effects of Medicaid eligibility on breast and cervical cancer screening among low-income populations.

Medicaid administrative claims and utilization data will allow us to consider the effects of changes in eligibility as well as physician payment and patient cost sharing on screening among Medicaid enrollees. Surveillance, epidemiology and end-results cancer registry data will be used to estimate the effects of changes in Medicaid generosity on cancer incidence and stage at diagnosis.

Intended policy outcomes

Findings from this study will provide evidence about the impact of public policies on cancer screening for underserved populations. The study will be the first to explore the effects of recent Medicaid policies on breast and cervical cancer screening and diagnosis among low-income women. The outcomes considered will also serve as an indicator of the effect of health reform on prevention and women’s health.