Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
Cancer. 2013 Mar 15;119(6):1257-65. doi: 10.1002/cncr.27848. Epub 2012 Dec 7.
There is increasing concern regarding the financial burden of care on cancer patients and their families. Medicare beneficiaries often have extensive comorbidities and limited financial resources, and may face substantial cost sharing even with supplemental coverage. In the current study, the authors examined out-of-pocket (OOP) spending and burden relative to income for Medicare beneficiaries with cancer.
This retrospective, observational study pooled data for 1997 through 2007 from the Medicare Current Beneficiary Survey linked to Medicare claims. Medicare beneficiaries with newly diagnosed cancer were selected using claims-based diagnoses. Generalized linear models were used to estimate OOP spending. Logistic regression models identified factors associated with a high OOP burden, defined as spending > 20% of one's income during the cancer diagnosis and subsequent year.
The cohort included 1868 beneficiaries with and 10,047 without cancer. Compared with the noncancer cohort, cancer patients were older, had more comorbidities, and were more likely to lack supplemental coverage. The mean OOP spending for cancer patients was $4727. Cancer patients faced an adjusted $976 (P < .01) incremental OOP spending. Greater than one-quarter (28%) of beneficiaries with cancer experienced a high OOP burden compared with 16% of beneficiaries without cancer (P < .001). Supplemental insurance and higher income were found to be protective against a high OOP burden, whereas assets, comorbidity, and receipt of cancer-directed radiation and antineoplastic therapy were associated with a higher OOP burden.
Medicare beneficiaries with cancer face a higher OOP burden than their counterparts without cancer; some of the higher burden was explained by the higher comorbidity burden and lack of supplemental insurance noted among these patients. Financial pressures may discourage some elderly patients from pursuing treatment.
人们越来越关注癌症患者及其家庭的护理经济负担。医疗保险受益人通常患有多种合并症且经济资源有限，即使有补充保险，他们也可能面临大量自付费用。在本研究中，作者研究了癌症医疗保险受益人的自付支出（OOP）和相对于收入的负担。
本回顾性观察研究从医疗保险当前受益人调查中汇集了 1997 年至 2007 年的数据，并与医疗保险索赔数据相关联。使用基于索赔的诊断方法选择新诊断患有癌症的医疗保险受益人。使用广义线性模型估计 OOP 支出。逻辑回归模型确定了与高 OOP 负担相关的因素，高 OOP 负担定义为在癌症诊断和随后的一年中支出超过收入的 20%。
该队列包括 1868 名患有癌症和 10047 名无癌症的受益人。与非癌症队列相比，癌症患者年龄更大，合并症更多，并且更有可能缺乏补充保险。癌症患者的平均 OOP 支出为 4727 美元。癌症患者的调整后 OOP 支出增加了 976 美元（P <.01）。与无癌症的受益人相比，超过四分之一（28%）的癌症患者经历了高 OOP 负担，而无癌症的受益人中有 16%（P <.001）。补充保险和较高的收入被发现可以预防高 OOP 负担，而资产、合并症以及接受癌症定向放疗和抗肿瘤治疗与更高的 OOP 负担相关。
癌症的医疗保险受益人比没有癌症的同龄人面临更高的 OOP 负担；这些患者中存在更高的合并症负担和缺乏补充保险，部分解释了较高的负担。经济压力可能会阻止一些老年患者接受治疗。
