Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland4Sidney Kimmel Comprehensive Cancer Center, Cancer Prevention and Control Program, Johns Hopkins School of Medicine, Baltimore, Maryland.
JAMA Oncol. 2017 Jun 1;3(6):757-765. doi: 10.1001/jamaoncol.2016.4865.
Medicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant cost sharing by beneficiaries.
To measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and identify which factors and services contribute to high OOP costs.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively collected survey data from 18 166 community-dwelling Medicare beneficiaries, including 1409 individuals who were diagnosed with cancer during the study period, who participated in the January 1, 2002, to December 31, 2012, waves of the Health and Retirement Study, a nationally representative panel study of US residents older than 50 years. Data analysis was performed from July 1, 2014, to June 30, 2015.
Out-of-pocket medical spending and financial burden (OOP expenditures divided by total household income).
Among the 1409 participants (median age, 73 years [interquartile range, 69-79 years]; 46.4% female and 53.6% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86; 95% CI, 1.55-2.23; P < .001; chronic noncancer condition: adjusted odds ratio, 1.82; 95% CI, 1.69-1.97; P < .001). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7% of their household income; 10% of these beneficiaries incurred OOP expenditures that were 63.1% of their household income. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6% of total OOP costs.
Medicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs associated with hospitalization may be a primary contributor to these high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.
由于癌症治疗费用昂贵，且患者需承担大量自付费用，因此患有癌症的医疗保险受益人面临经济困难的风险。
衡量癌症患者的自付费用，并确定哪些因素和服务导致自付费用高。
设计、地点和参与者：我们前瞻性地从参加 2002 年 1 月 1 日至 2012 年 12 月 31 日健康与退休研究（一项针对美国 50 岁以上居民的全国代表性小组研究）的 18166 名社区居住的医疗保险受益人中收集了调查数据，其中包括 1409 名在研究期间被诊断患有癌症的个体。数据分析于 2014 年 7 月 1 日至 2015 年 6 月 30 日进行。
自付医疗支出和经济负担（自付支出除以家庭总收入）。
在研究期间被诊断患有癌症的 1409 名参与者（中位数年龄为 73 岁[四分位间距，69-79 岁]；46.4%为女性，53.6%为男性）中，补充保险类型与癌症诊断后发生的年度平均自付费用显著相关（由医疗补助保险承保的为 2116 美元，由退伍军人健康管理局承保的为 2367 美元，由医疗保险健康维护组织承保的为 5976 美元，由雇主赞助的保险承保的为 5492 美元，由补充保险承保的为 5670 美元，由传统按服务收费的医疗保险承保但没有补充保险的为 8115 美元）。新发癌症或常见非癌症慢性疾病诊断与发生最高十分位数自付支出的几率增加相关（癌症：调整后的优势比，1.86；95%CI，1.55-2.23；P<0.001；非癌症慢性疾病：调整后的优势比，1.82；95%CI，1.69-1.97；P<0.001）。新诊断癌症且仅由医疗保险承保的患者自付支出占其家庭收入的平均 23.7%；其中 10%的患者自付支出占其家庭收入的 63.1%。在自付支出最高的 10%癌症患者中，住院治疗占总自付支出的 41.6%。
没有补充保险的医疗保险受益人在癌症诊断后会产生大量的自付费用。与住院相关的费用可能是这些高自付费用的主要原因。对基于医院的服务进行福利设计改革并纳入自付最高额的医疗保险改革方案，以及采取减少该人群住院治疗的干预措施，可能有助于减轻经济负担。
