Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States |
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| Institution: | 1. Dentistry Postgraduate Research Program, Rio de Janeiro State University, Rio de Janeiro, Brazil;2. H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal;3. Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil;4. Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropedica, Brazil;1. Texas A&M Irma Lerma Rangel College of Pharmacy, 1010 W. Avenue B, Kingsville, TX, 78363, USA;2. University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA;3. University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL, 32610, USA;1. Sonderegger Research Center for Improved Medication Outcomes, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI, 53705, United States;2. University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, 777 Highland Ave., Madison, WI, 53705, United States;3. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI, 53705, United States;1. School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, St Stephens Green, Dublin 2, Ireland;2. TU Dublin School of Creative Arts, Technological University Dublin, Dublin 7, Ireland;3. School of Medicine, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin 9, Ireland;4. Department of Health Psychology, RCSI University of Medicine and Health Sciences, St Stephens Green, Dublin 2, Ireland;5. UCD Centre for Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland;6. Department of Product Design, National College of Art and Design, 100 Thomas Street, Dublin 8, Ireland;1. Geisinger Commonwealth School of Medicine, Scranton, PA, USA;2. Binghamton University, Binghamton, NY, USA;3. University of New England, Portland, ME, USA;4. Center for Pharmacy Innovation & Outcomes, Danville, PA, USA |
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| Abstract: | BackgroundHealth care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.MethodsA cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.ResultsA total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.ConclusionsA difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care. |
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| Keywords: | Cancer survivors Health care expenditures Insurance coverage Medical expenditure panel survey |
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