TY - JOUR
T1 - Health services utilization, out-of-pocket expenditure, and underinsurance among insured non-elderly cancer survivors in the United States, 2011–2015
AU - Karim, Mohammad A.
AU - Singal, Amit G.
AU - Ohsfeldt, Robert L.
AU - Morrisey, Michael A.
AU - Kum, Hye Chung
N1 - Funding Information:
This work was conducted with support in part by the Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University and Texas Virtual Data Library (ViDaL) funded by the Texas A&M University Research Development Fund, and a cancer prevention fellowship for Mohammad A. Karim, supported by the Cancer Prevention and Research Institute of Texas grant award RP170259 (PI: Shine Chang, PhD and Sanjay Shete, PhD). Dr. Singal's research is funded in part by NIH R01 MD012565. The content is solely the responsibility of the authors and does not necessarily represent the official views of Texas A&M University, Cancer Prevention and Research Institute of Texas or National Institute of Health.
Publisher Copyright:
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2021/8
Y1 - 2021/8
N2 - Background: High out-of-pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors. Methods: We used 2011–2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non-elderly adult (age 18–64 years) cancer survivors. We used negative binomial, two-part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome. Results: We identified 2738 insured non-elderly cancer survivors. Adjusted average utilization of ambulatory, non-ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non-Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non-ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service-specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured. Conclusion: Many insured non-elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare-related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.
AB - Background: High out-of-pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors. Methods: We used 2011–2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non-elderly adult (age 18–64 years) cancer survivors. We used negative binomial, two-part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome. Results: We identified 2738 insured non-elderly cancer survivors. Adjusted average utilization of ambulatory, non-ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non-Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non-ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service-specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured. Conclusion: Many insured non-elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare-related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.
KW - cancer
KW - health services
KW - insurance
KW - out-of-pocket expenditure
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U2 - 10.1002/cam4.4103
DO - 10.1002/cam4.4103
M3 - Article
C2 - 34327859
AN - SCOPUS:85111584068
SN - 2045-7634
VL - 10
SP - 5513
EP - 5523
JO - Cancer Medicine
JF - Cancer Medicine
IS - 16
ER -