Health insurance and its impact on the survival rates of breast cancer patients in Synthea

• DOI: http://doi.org/10.1111/rmir.12138
• Author: Shamsnaz V. Bhada,Robert Scalfani
• Published date: 01 March 2020
• Date: 01 March 2020

© 2020 The American Risk and Insurance Association

Risk Manag Insur Rev. 2020;23:7–29. wileyonlinelibrary.com/journal/rmir

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Received: 7 January 2020

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Accepted: 8 January 2020

DOI: 10.1111/rmir.12138

INVITED ARTICLE

Health insurance and its impact on the survival

rates of breast cancer patients in Synthea

Robert Scalfani

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Shamsnaz V. Bhada

Department of Computer Science,

Worcester Polytechnic Institute,

Worcester, Massachusetts

Correspondence

Robert Scalfani, Department of Computer

Science, Worcester Polytechnic Institute,

Worcester, MA.

Email: robis345@gmail.com

Abstract

The goal of this project was to build policy modules in a

synthetic health system to analyze how healthcare policy

impacts breast cancer survival rates. To do any inference

regarding healthcare policy, researchers need secure and

protected health data, which are restricted by privacy

laws and interoperability issues. Synthetic health systems

generate and help investigate health data without

concerns of violating legal restrictions (HIPAA). In this

research, we programmed health insurance and loss‐of

‐care modules into a synthetic health system simulator

(Synthea) to simulate and analyze the impact of health

insurance on breast cancer survival rates. Our goal was

for our health insurance and loss‐of‐care implementa-

tions to be realistic and reflective of the real world, in

which we were successful.

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INTRODUCTION

Health Insurance is a key part of the American healthcare system (Bovbjerg & Hadley, 2007).

As health insurance increases people's access to care, it leads to better health outcomes for a

population (Bovbjerg & Hadley, 2007). Health insurance is also subject to government policy over

its implementation (Healthcare.gov, 2019). Like all policy, its implementation can be decided

through the use of data, which provide insight on the public health implications and statistics of

policy. However, health data are subject to barriers to its access, including interoperability issues

(Monica, 2017) and legal restrictions (Institute of Medicine, 2013). Without access to the complete

health data that policy analysis is based on, researchers and policy makers face difficulties in

making fully informed conclusions and inferences about health policy, including health insurance.

One way to bypass the issues that accessing health data presents is through the use of

Synthea. Synthea is an open‐source health data simulator developed by the MITRE Corporation

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that creates synthetic, yet realistic, health data. It generates complete health record histories for

each individual patient, allowing for the creation of realistic data that can be analyzed.

However, Synthea assumes that patients receive all of the care that they need, which is

unrealistic. Synthea also does not currently feature health insurance or loss‐of‐care impacts as

realsitically modeled features. When policy makers and researchers cannot analyze health

insurance and policy impacts, they cannot make the best decisions for the healthcare industry.

In this research, we implemented health insurance and loss‐of‐care modules into Synthea to

analyze the impacts that health insurance has on the survival rates of breast cancer patients.

Breast cancer patients were the population focus used for this research as a way to limit the

scope for our initial research. We chose survival rates as the metric to measure because it is

used in real‐world policy analysis (Thacker & Stroup, 2006). The survival rates of breast cancer

patients are well‐documented, which allowed us to simulate, analyze, and verify it in Synthea.

Our implementation of health insurance in Synthea could be used for future health policy

and research analysis. We established our newly developed health insurance and loss‐of‐care

modules to be reflective of real life and that health insurance has a positive impact on survival

rates. Health insurance, as an important aspect of health policy, is regulated based on health

data. Because of the difficulties in accessing health data, both for analysis and to measure the

impact of different policies, we modeled and simulated health insurance in Synthea to find its

impact on the survival rates of breast cancer patients.

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BACKGROUND

Health insurance in the United States has undergone years of policy change and debate. But, like

any public policy, the decision over how health insurance should be implemented requires a

complete understanding of the situation. Understanding the complete picture requires using data

and analysis. Health data can determine health policy, including with regard to health insurance, is

through the use of population survival rates. However, researchers struggle to evaluate the survival

rate data due to the barriers of access to health data. Health data barriers include interoperability

and privacy restrictions, which have resulted in incomplete and inaccessible data. One way that a

researcher could get a complete and realistic picture of health and survival rate data is through the

use of Synthea, a synthetic health record and patient generation software. By simulating a

population of health records and health insurance companies, realistic, yet synthetic, data could be

produced that allows for the analysis of survival rates based on different policies. It even allows for

the ability to easily change variables to see the different impacts that they could have.

For the scope of this paper, we tested the impact that health insurance can have on the

survival rate of breast cancer patients, with the expectation that this research and

implementation could expand to include more, and eventually all, diseases. To provide a

background for the topics of the paper, this chapter describes several topics: health insurance

and its impacts, researchers' use of survival rate data, health data barriers, Synthea, breast

cancer, and the real‐world data used for this paper.

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Health insurance in the United States

Health insurance exists as a way for patients to overcome the high costs of healthcare expenses

(Pitts, 2019). These expenses add up and include everything from treatment for serious

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SCALFANI AND BHADA