National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008
National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008
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DOI：
10.1200/jco.2010.33.0522
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发表时间：
2011-07-10
影响因子：
45.3
通讯作者：
Fang, Zhengyi
中科院分区：
文献类型：
--
作者：
Bernard, Didem S. M.;Farr, Stacy L.;Fang, Zhengyi
目的比较癌症患者与其他慢性病患者和健康患者中高自付费用的发生率，并检查癌症患者中与高负担相关的社会人口学特征。方法样本包括接受癌症治疗的 18 至 64 岁人群，取自 2001 年至 2008 年医疗支出小组调查的美国人口全国代表性样本。我们研究了生活在与医疗支出（包括保险费）相关的高自付费用家庭中的人员相对于收入的比例，将高医疗保健（总）负担定义为医疗保健（和保费）支出超过收入的 20%。结果与其他慢性病患者和健康患者相比，癌症患者承受高负担的风险明显更大。我们发现，13.4% 的癌症患者总负担较高，而患有其他慢性病的患者的总负担为 9.7%，无慢性病的患者为 4.4%。在非老年癌症患者中，以下因素与较高的自付费用负担相关：私人非团体保险、年龄 55 至 64 岁、非西班牙裔黑人、从未结婚或丧偶、独生子女或无子女、失业、收入较低、教育水平较低、居住在非大都市统计区域以及患有其他慢性病。 结论 高负担可能会影响治疗选择并阻止患者获得护理。因此，尽管对护理费用进行详细的患者与医生讨论可能不可行，但我们相信，了解癌症患者的自付费用对于临床肿瘤学家来说是有用的。
PurposeTo compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer.MethodsThe sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums).ResultsThe risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions.ConclusionHigh burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.