South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
J Rural Health. 2019 Mar;35(2):199-207. doi: 10.1111/jrh.12301. Epub 2018 Apr 15.
The purpose of this study was to examine rural-urban differences in utilization and expenditures in the last 6 months of life for patients with breast, lung, or colorectal cancer.
The study used a 5% sample of the 2013 Medicare Research Identifiable Files to study utilization and expenditures for beneficiaries with breast, lung, or colorectal cancer during the last 6 months before death (n = 6,214). End of life expenditures were calculated as the sum of total Medicare expenditures for inpatient, outpatient, physician, home health, hospice, and skilled nursing facility costs during the last 6 months of life.
For each type of cancer, total Medicare expenditures in the last 6 months of life were lower for rural decedents compared to their urban counterparts. During the last 6 months of life, median Medicare expenditures were lower for rural decedents for breast cancer ($21,839 vs $25,698), lung cancer ($22,814 vs $27,635), and colorectal cancer ($24,156 vs $28,035; all differences significant at P < .05). In adjusted models, care for rural decedents was less costly than urban decedents for breast, lung, and colorectal cancer, respectively.
Our findings indicate that Medicare expenditures are lower for rural beneficiaries with each type of cancer than urban beneficiaries, even after adjusting for age, gender, race, dual eligibility, region, chronic conditions, and type of service utilization. The findings from this study can be useful for policymakers in developing programs and resource allocation decisions that impact rural beneficiaries.
本研究旨在考察农村和城市地区乳腺癌、肺癌和结直肠癌患者在生命最后 6 个月的利用和支出差异。
该研究使用了 2013 年医疗保险研究可识别文件的 5%样本，研究了在死亡前最后 6 个月内患有乳腺癌、肺癌或结直肠癌的受益人的利用和支出（n=6214）。终末期支出被计算为生命最后 6 个月内住院、门诊、医生、家庭健康、临终关怀和熟练护理设施费用的医疗保险总支出之和。
对于每一种癌症，农村死者的医疗保险总支出在生命的最后 6 个月都低于城市死者。在生命的最后 6 个月，农村死者的医疗保险中位数支出低于城市死者：乳腺癌（21839 美元对 25698 美元）、肺癌（22814 美元对 27635 美元）和结直肠癌（24156 美元对 28035 美元；所有差异均具有统计学意义，P<.05）。在调整后的模型中，农村死者的护理费用分别低于乳腺癌、肺癌和结直肠癌的城市死者。
我们的研究结果表明，即使在调整了年龄、性别、种族、双重资格、地区、慢性疾病和服务利用类型后，农村受益人的每一种癌症的医疗保险支出都低于城市受益人的医疗保险支出。本研究的结果对于制定影响农村受益人的项目和资源分配决策的政策制定者来说是有用的。
