You Chang Hoon, Kang Sungwook, Kwon Young Dae
Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea.
Department of Public Health, Daegu Haany University, 1 Haanydaero, Gyeongsan, Korea.
Asian Pac J Cancer Prev. 2019 Jul 1;20(7):2131-2137. doi: 10.31557/APJCP.2019.20.7.2131.
Background: This study analyzed the burden of cancer treatment costs on patients by calculating the monthly amount of medical expenses paid by breast cancer patients for two years after mastectomy. Methods: Among those who were diagnosed with breast cancer and had received treatment at one of two academic medical centers in Seoul between 2003 and 2011, 1,087 patients who underwent mastectomy and received follow-up for at least two years were recruited. A micro-costing approach from the provider’s perspective, based on a retrospective review of patient medical claim records, was used to analyze cancer treatment cost of care. The cohort’s number of hospitalizations, total hospitalization duration, and number of outpatient visits were noted, and the total amount of medical expenses, out-of-pocket (OOP) expenditures, uninsured costs, and OOP ratio were calculated. Results: The total amount of medical expenses tended to increase by year, whereas the OOP expenditure ratio decreased. The OOP expenditure ratio was highest in the first month post-operation. Around one quarter of the total OOP payments incurred over the course of three months: one month before the operation, the month of the operation, and one month post-operation. Conclusion: OOP payment burden on patients was concentrated in the initial phase of treatment, and items not covered by the National Health Insurance caused an additional increase in patients’ burden in the initial phase. The economic burden of cancer treatment varies considerably. In order to alleviate patients’ medical expenses burden, the timing of expenditures and the possible financial burden on cancer survivors, they should be understood more fully and possibly addressed in interventions aimed at reducing the cancer burden.
本研究通过计算乳腺癌患者乳房切除术后两年每月支付的医疗费用金额，分析了癌症治疗费用对患者的负担。方法：在2003年至2011年期间于首尔的两家学术医疗中心之一被诊断为乳腺癌并接受治疗的患者中，招募了1087例行乳房切除术并接受至少两年随访的患者。基于对患者医疗理赔记录的回顾性审查，采用从提供者角度的微观成本核算方法来分析癌症治疗护理费用。记录该队列的住院次数、总住院时长和门诊就诊次数，并计算医疗费用总额、自付费用、未保险费用和自付费用比例。结果：医疗费用总额呈逐年上升趋势，而自付费用比例下降。自付费用比例在术后第一个月最高。约四分之一的自付费用发生在三个月内：手术前一个月、手术当月和术后一个月。结论：患者的自付费用负担集中在治疗初期，国民健康保险未涵盖的项目导致患者在初期负担进一步增加。癌症治疗的经济负担差异很大。为了减轻患者的医疗费用负担、支出时间以及癌症幸存者可能面临的经济负担，应更全面地了解这些情况，并在旨在减轻癌症负担的干预措施中加以解决。
