Riley G F, Potosky A L, Lubitz J D, Kessler L G
Health Care Financing Administration, Baltimore, MD 21207-5187, USA.
Med Care. 1995 Aug;33(8):828-41. doi: 10.1097/00005650-199508000-00007.
Although extensive resources go to cancer care, national population-based data on the costs of such care at the patient level have been unavailable. Medicare payments subsequent to diagnosis of cancer for elderly enrollees with five common cancers were estimated using tumor registry data from the Surveillance, Epidemiology, and End Results Program linked to Medicare claims from 1984 to 1990. The time between diagnosis and death was divided into four phases corresponding to the clinical course of solid tumors, average payments for each phase were estimated (including payments for services not related to cancer), then phase-specific payment data were aggregated. Average payments by phase varied among cancer sites, especially in the initial care phase, where payments were highest for lung and colorectal cancers ($17,500 in 1990 dollars) and lowest for female breast cancer ($8,913). Total Medicare payments from diagnosis to death were highest for persons with bladder cancer ($57,629) and lowest for those with lung cancer ($29,184). Low payments for persons with lung cancer corresponded to brief survival times. Persons diagnosed at earlier stages incurred higher total payments between diagnosis and death than those diagnosed at later stages, reflecting their longer survival. This implies that early detection may increase total Medicare expenditures by extending beneficiaries' lives. However, Medicare payments per year of survival were lower for earlier stages. Data on Medicare payments subsequent to diagnosis of cancer are useful for identifying the cost implications of differences in treatment patterns by demographic characteristics, geography, and delivery systems; comparing the financial impact of alternative therapies; evaluating the long-term cost impacts of screening and prevention programs; and risk-adjusting payments to health plans.
尽管大量资源用于癌症治疗，但一直没有基于全国人口的患者层面此类治疗费用的数据。利用监测、流行病学和最终结果计划的肿瘤登记数据与1984年至1990年医疗保险理赔数据相链接，估算了患有五种常见癌症的老年参保人在癌症诊断后的医疗保险支付情况。将诊断至死亡的时间分为与实体瘤临床病程相对应的四个阶段，估算每个阶段的平均支付情况（包括与癌症无关的服务支付），然后汇总各阶段特定的支付数据。各阶段的平均支付情况因癌症部位而异，尤其是在初始治疗阶段，肺癌和结直肠癌的支付最高（以1990年美元计为17,500美元），女性乳腺癌的支付最低（8,913美元）。从诊断到死亡的医疗保险总支付中，膀胱癌患者最高（57,629美元），肺癌患者最低（29,184美元）。肺癌患者支付较低与生存时间较短相对应。早期诊断的患者在诊断至死亡期间的总支付高于晚期诊断的患者，这反映了他们更长的生存期。这意味着早期检测可能会通过延长受益人的生命而增加医疗保险总支出。然而，早期阶段每年的生存医疗保险支付较低。癌症诊断后的医疗保险支付数据有助于确定人口特征、地理位置和医疗服务提供系统等方面治疗模式差异的成本影响；比较替代疗法的财务影响；评估筛查和预防计划的长期成本影响；以及对健康计划进行风险调整支付。
