DC Cancer Consortium

DC has the highest cancer mortality rate in the nation. Mortality rates for prostate, colon and breast cancer -- and cancer in general -- are generally higher in DC than anywhere in the country.

DC is rich in health care facilities: There are 11 hospitals and medical centers, and many excellent cancer care services. In general, these services are neither accessible nor affordable for many of the City's neediest residents -- the poor and medically underserved (uninsured and under-insured) populations, many of whom are Black or Hispanic.

Lack of insurance or underinsurance is a very significant factor contributing to disparities in cancer care in the District:

In 1999, 60% of DC adults may have qualified for Medicaid or DC HealthCare Alliance coverage, based on income.
In 1999, 36% of the income of adults over age 65 fell below 200% of the federal poverty level, possibly qualifying them for Medicaid.
Although the percentage of uninsured in DC is lower than the national average, the percent of residents who live in poverty (20.3%) is higher than the national average (12.4%), showing that proportionately there are more people in DC who are uninsured and poor.
The gap between the wealthy and the poor is widening in DC, and is as wide as or wider than the poverty gap in any other major US city.
The adult populations in DC most likely to be uninsured are poor, Black or Hispanic, and male. The Hispanic population has the highest uninsured rate, being poorer than Blacks or Whites, and having worse health indicators that both groups.

Too few health care professionals and services exist in low-income neighborhoods.

In 2001, DC had the highest physician-to-population ratio of any state, but most physicians do not work in low-income neighborhoods.
According to the Bureau of Primary Care of the US Department of Health & Human Services, 300,825 DC residents (52% of the total population) live in federally-designated primary care Health Professional Shortage Areas, and 173,228 (30% of the population) live in federally-designated Medically Underserved Areas.

Many residents lack a "medical home" -- A "medical home" is a primary care provider who knows a patient's health history and provides non-emergency care. The DC Primary Care Association (DCPCA) has correctly linked the lack of adequate primary care to poorer health outcomes, higher costs, overused and overcrowded emergency rooms.

Too few specialists serve poor neighborhoods. The DC HealthCare Alliance has had difficulty enrolling and maintaining oncologists and other specialists, because of low, and slow reimbursement rates.

Community health centers are only loosely linked to each other and to other parts of the health care system for services like diagnostic follow-up, cancer treatment, behavioral health and more. The health centers also report difficulty in retrieving reports from specialists on Alliance and Medicaid patients. In turn, at times the community health centers have difficulty in submitting information and billing in timely manner to contractors and health plans.

The complexities of health care for the poor are staggering and compounded by a sea of sometimes-conflicting regulations, inconsistency of information provided, language problems, cultural issues, literacy issues, and more. A city-wide system of patient navigation for cancer patients is urgently needed for DC's medically underserved and vulnerable populations.