Insurance, chronic health conditions, and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report

Survivors of childhood cancer require life-long outpatient healthcare, which be impacted by health insurance. this study sought to understand survivors’ utilization of outpatient healthcare provider services. the study examined cross-sectional survey data using an age-stratified sample from the childhood cancer survivor study of self-reported annual use of outpatient services. multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (pcp), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician’s assistants (np/pa), and 14.2% were with survivorship clinic providers. survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (or = 5.15, 95% ci 2.89–9.17) or a survivorship clinic (or = 2.93, 95% ci 1.18–7.26) than those with no chronic health conditions. having health insurance increased the likelihood of seeking care from np/pa (private, or = 2.76, 95% ci 1.37–5.58; public, or = 2.09, 95% ci 0.85–5.11), pcp (private, or = 7.82, 95% ci 3.80–13.10; public, or = 7.24, 95% ci 2.75–19.05), and specialty care (private, or = 2.96, 95% ci 1.48–5.94; public, or = 2.93, 95% ci 1.26–6.84) compared to without insurance. most childhood cancer survivors received outpatient care from a pcp, but a minority received care from a survivorship clinic provider. having health insurance increased the likelihood of outpatient care. targeted interventions in the primary care setting improve risk-based, survivor-focused care for this vulnerable population.