Medical Expenditures of Cancer Survivors Under Age 65
Year: 2010
Type: preprint
Study design: Observational Study
Abstract: This study estimates total and out-of-pocket medical expenditures for U.S. cancer survivors under age 65, by type of service. Such estimates are not routinely available from the Medical Expenditure Panel Survey (MEPS), because MEPS did not systematically identify respondents ever diagnosed with cancer until 2007. Previous studies have estimated national expenditures for older survivors from Medicare claims, but have excluded prescription and dental expenditures and are not easily generalized to younger survivors, particularly with regard to out-of-pocket spending. With the questionnaire change, MEPS will eventually support expenditure estimates for younger survivors, but not until multiple years of data can be pooled to yield reliable estimates. In the meantime, the information is urgently needed to inform decisions about the design and implementation of national health insurance reforms that could profoundly affect the 5 million Americans under age 65 who are cancer survivors. Expenditures from MEPS for 2001-2006 were linked with the National Health Interview Survey (NHIS), the MEPS sampling frame, to identify MEPS cases ever diagnosed with cancer according to NHIS. Because the NHIS checklist identifying cancer survivors is administered to one sampled adult per household, MEPS survey weights were adjusted to yield national estimates from NHIS sampled adults linking to MEPS. To produce 2006 estimates from data pooled over multiple years, survey weights were re-scaled to sum to the 2006 population, and expenditures were inflated by service-specific components of the Personal Health Care Expenditure index from CMS. Ongoing multivariate analyses, involving both regression-based approaches and propensity-score matching, will quantify expenditure differences specifically attributable to cancer. Estimates are provided for all U.S. cancer survivors ages 25 to 64, corresponding to prevalence at the end of 2006. Expenditures are reported separately for (1) recently diagnosed survivors, not identified in NHIS, who were identified from cancer-related utilization or disability in MEPS and (2) longer term survivors identified in NHIS. Previous estimates for cancer survivors from MEPS have been limited to “affected prevalence,” i.e., respondents reporting cancer-related utilization or disability during the survey year. Mean total expenditures were about $15,400 annually for recently diagnosed survivors and $7400 for longer term survivors, compared to $3200 for other adults. Out-of-pocket expenditures averaged about $2200 for recently diagnosed survivors, $1400 for longer term survivors, and $700 for other adults. Prescriptions accounted for a disproportionate share of out-of-pocket expenses in all subgroups, but were particularly costly for longer term survivors--whose prescriptions accounted for 23% of total expenses, and 48% of out-of-pocket expenses. Public insurance financed 20% of the expenses of longer term survivors (12% Medicare and 8% Medicaid), compared to 16% for recently diagnosed survivors (4% Medicare and 12% Medicaid) and 15% for other adults (6% Medicare and 9% Medicaid). Thus, cancer survivors spent two to three times more out-of-pocket than other adults, particularly for prescriptions. Even for long-term survivors, total spending averaged $4000 more per year. Because cancer survivors are at risk of spending considerably more on health care than most other American adults, they may be particularly affected by the details of health insurance reforms.
Source: SSRN Electronic Journal
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W3186983272