Association of the affordable care act with perceived health care quality of cancer survivors

Background: The association between the Patient Protection and Affordable Care Act (ACA) and perceptions of health care quality of cancer survivors is not well established. The purpose of this study was to examine changes in perceived health care quality concurrent with the implementation of the ACA among cancer survivors relative to a non-cancer comparison group.

Methods: We used cross-sectional data from the Health Information National Trends Survey (N = 30,542). Participants were considered cancer survivors if they had a diagnosis greater than five years before the interview. The pre-ACA period included the years 2008 through 2014. The post-ACA period included 2017 through 2020. Using difference-in-differences methods, we estimated the association of ACA implementation with perceived health care quality (measured from excellent to fair/poor) using propensity score-matched cancer survivors (n = 2298) and a non-cancer comparison group (n = 6669) with weighted logistic models.

Results: There were similar distributions of perceptions of excellent, very good, good, and fair/poor health care quality regardless of cancer status or time-period. The pre-post ACA implementation difference of reporting excellent, very good and good health care quality (odds ratio [OR]: 1.0, 95% confidence interval [CI]: 0.83-1.19; OR: 0.98, 95% CI 0.83-1.19; and OR: 1.05, 95% CI: 0.87-1.28 respectively) compared to fair/poor was similar in cancer survivors relative to the non-cancer comparison group.

Conclusions: The initial implementation of the ACA appeared to have no effect on perceived overall health care quality reported by cancer survivors when compared to individuals without a history of cancer. Health care policies and domains which continue to support better patient-perceived care quality should be assessed in the cancer survivor population.