Transcript Out-of-Pocket Costs among Women with Breast Cancer: Data

Out-of-pocket healthcare expenditures for cancer patients in the United States:
Findings from the Medical Expenditure Panel Survey
Lisa M. Lines, MPH1,2
1Boston
2University of Massachusetts Amherst, Amherst, MA USA
Health Economics, Inc., Waltham, MA USA
Presented at the 9th Annual Health Services and Outcomes Research Conference, Houston, TX, December 3, 2008
Background and Objectives
Results
 From 1996 to 2002, OOP medical spending increased by 35%—faster than overall medical spending; meanwhile,
incomes rose by only about 20% over the same period1
 Cancer patients are disproportionately affected by high OOP burdens
 A total of 10,048 individuals with a cancer event were included (mean age=54.7; 88% white; 23% low income)
(Table 1)
Figure 2: Percent with high OOP burden by income and age
group
 Approximately 48% were privately insured, 25% had both Medicare and private insurance, 14% had Medicare only,
5% had Medicaid and/or another form of public insurance, and 8% were uninsured (Table 1)
Low income
 Having a high OOP burden may put patients at risk of nonadherence to prescribed treatment, of opting out of
receiving treatment perceived as too expensive, or of not being offered the treatment
 Previous studies on OOP spending by cancer patients have presented the results of analyses limited to specific
populations (elderly vs. nonelderly) or years2-5
 The purpose of this study was to describe the OOPEs of cancer patients in the US using a population-based approach
89%
 Mean family income was $73,204, and annual OOP expenditures totaled $5,775, or 8% of family income (Table 2)
 The bulk of OOP expenditures were for monthly insurance premiums (75%); about 11% of expenditures went toward
prescription drugs (Table 2)
 In unadjusted analyses, older and low-income individuals were most likely to have a high burden (Figure 2)
 Persons with cancer were nearly twice as likely as those without cancer to have a high burden (Figure 3)
Methods
68%
70%
67%
62%
60%
54%
53%
50%
42%
40%
35%
29%
30%
24%
Figure 1: Percent with high OOP burden, by payor
 Data from all 10 years were pooled and weighted (using the year-specific MEPS person-weight variables) to create
nationally representative, “average annual” estimates
 Descriptive analyses of demographics, socioeconomics, and insurance status were performed
– Individuals were categorized as uninsured if they were not covered by Medicare, Medicaid, other public programs, private
insurance, or TRICARE during 1 or more months during the year
 Total annual family income and person-level total and OOP expenditures (in 2007 US$) were calculated
– Family incomes were calculated by summing the incomes of all persons in a household who were identified as being in the
same family (using the CPSFAMID variable) and categorized by poverty category as follows: low income: <200% of the
Federal poverty level (FPL); middle income: 200-399% of FPL; high income: >400% of FPL
 Patient-level OOP expenditures were calculated, including copayment or coinsurance expenditures, deductibles,
payments for non-covered expenses, and monthly insurance premiums
– Part B premiums were added to OOP expenditures for Medicare enrollees using published year-specific
dual eligibles were assumed to be covered by Medicaid
data;6
premiums for
– OOP expenditures for privately insured individuals included actual monthly premiums paid for respondents in the years
2001-2005 and averages from those years applied to respondents in 1996-2000 (premium data were not collected in 199799)
 As in previous studies, individuals were defined as having a high OOP burden if their OOP expenditures exceeded
10% of family income (or 5% if low income), including monthly insurance premiums1,7
Unweighted N
Age
Mean
<45 years
45 to 54 years
55 to 64 years
65 to 74 years
75+ years
10,048
57%
60%
51%
50%
44%
41%
54.5
27.8%
16.1%
17.6%
20.5%
18.0%
88.1%
5.7%
4.0%
1.6%
0.6%
Education
Less than 12 years
12 years or GED
More than 12 years
Unknown
17.8%
30.3%
50.5%
1.5%
Income
Low income
Middle income
High income
23.2%
29.6%
47.2%
48.1%
13.8%
24.9%
5.4%
7.8%
42%
40%
31%
30%
18%
17%
13%
10%
4%
0%
<45
45 - 54
55 - 64
65-74
75+
All
Nonelderly
Elderly
Low income
Age
Middle
income
High
income
Demographic Group
80%
Race/ethnicity
White, non-Hispanic
African American, non-Hispanic
Hispanic, any race
Asian or Pacific Islander
Multiple races/other
Payor
Private only
Medicare only
Medicare + private
Medicaid/dual/other public
Uninsured
Source: MEPS 1996-2005
13%
0%
90%
Percent with high burden
 This study included all respondents with known ages, incomes, and insurance status in MEPS between 1996 and
2005 who had a cancer diagnosis (ICD-9-CM codes 140-239) recorded for at least 1 pharmacy, inpatient, outpatient,
office, home health, or ER event during a 12-month time period
70%
20%
10%
Estimate
75%
23%
17%
13%
100%
Measure
80%
80%
20%
Table 1: Demographics of individuals
receiving care for cancer
90%
85%
80%
 The percent with high burden was highest among those with both Medicare and private insurance or Medicare only
(Figure 1)
Cancer population
100%
90%
Percent with high burden
– Improvements in treatment and survival have led to more patients living with cancer as a chronic condition
General population
High income
100%
 Overall, approximately 41% of individuals had a high OOP burden (Figure 1)
– Today, most cancer care is performed in the outpatient oncology setting, which may expose patients to a greater share of
total costs than in the past
Middle income
Figure 3: Comparison of percent with high burden, general
population and cancer population
Percent with high burden
 There is an increasing focus on the impact of out-of-pocket (OOP) medical expenditures on individuals in the US
healthcare system
70%
63%
Conclusions
60%
49%
50%
41%
 Among individuals with cancer, the average OOP expenditure, including monthly insurance premiums, was $5,775,
and over 40% of individuals had a high OOP burden
40%
32%
30%
24%
22%
 The proportion of individuals with a high OOP burden was highest among low-income and older individuals and those
with Medicare plus private insurance
20%
10%
 Because cancer patients with high OOP burdens may have difficulty receiving optimal treatment, it is important to
explore ways to reduce OOP expenditures for these individuals
0%
All
Private
Medicare
Medicare&pvt
Medicaid/public
Uninsured
Payor
References
Table 2: Annual income, OOP expenditures, and share of
family income, overall and by payor
All
Private only
Medicare only
Medicare + private
Medicaid/dual/other public
Uninsured
Mean Annual
Family Income
$73,204
$95,697
$44,293
$58,114
$34,870
$60,268
OOPEs for
Prescription
Drugs
$616
$397
$1,147
$825
$471
$466
Total Annual
Total OOP Share
OOPEs
of Family Income
(incl. premiums) (incl. premiums)
$5,775
8%
$7,121
7%
$3,221
7%
$6,635
11%
$946
3%
$2,581
4%
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