Hu Jiamin, Khan Mishal, Chen Xiaobei, Revere Lee, Hong Young-Rock
Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, USA.
College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA.
Healthcare (Basel). 2024 May 20;12(10):1049. doi: 10.3390/healthcare12101049.
In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic.
We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM.
Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM.
While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.
在美国，由于癌症治疗费用高昂且费用分担责任增加，被诊断患有癌症的医疗保险受益人常常面临重大经济挑战。然而，与传统按服务收费的医疗保险（TM）参保者相比，关于新冠疫情期间医疗保险优势计划（MA）参保者所面临的经济困难和医疗保健利用情况的了解有限。我们的研究旨在调查参加TM和MA的个人所经历的主观经济困难，并确定这两种医疗保险计划在疫情期间的医疗保健利用方面是否存在差异。
我们利用了2020 - 2022年国家健康访谈调查（NHIS）的数据，重点关注65岁及以上癌症幸存者的全国代表性样本。经济困难分为三个不同类别：物质方面（如医疗账单问题）、心理方面（如担心支付费用）和行为方面（如因费用而推迟治疗）。医疗保健利用包括健康检查（预防保健）、急诊服务、住院治疗和远程医疗。我们使用经调查设计调整的分析方法来比较MA和TM之间的研究结果。
在440万患有癌症的医疗保险受益人的加权样本中（平均年龄：74.9岁），76%参加了MA计划。拥有大学学位（59.3%对49.8%）和家庭收入高（38.2%对31.1%）的癌症幸存者更有可能参加MA计划。除了因费用而放弃咨询外，MA和TM计划的受益人在任何物质、心理或行为经济困难领域均无显著差异。对于医疗保健利用指标，MA中的癌症幸存者比TM中的幸存者更有可能接种流感疫苗（77.2%对70.1%）且住院率更低（16.0%对20.0%）。然而，MA和TM在其他医疗服务利用方面没有差异。
虽然在任何物质、心理或行为经济困难方面均未观察到显著差异，但参加MA计划的老年癌症幸存者在新冠疫情期间更有可能接种疫苗且住院率更低。尽管其他预防性或初级保健就诊（即健康检查）次数较多，但其差异未达到统计学显著性。随着MA越来越受欢迎，在我们应对疫情后局面时，持续监测和评估针对癌症幸存者的医疗保险计划的表现和结果至关重要。
