Out-of-pocket health-care expenditures among older Americans with cancer
Out-of-pocket health-care expenditures among older Americans with cancer
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DOI：
10.1111/j.1524-4733.2004.72334.x
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发表时间：
2004-03-01
期刊：
影响因子：
4.5
通讯作者：
Hayman, JA
中科院分区：
文献类型：
--
作者：
Langa, KM;Fendrick, AM;Hayman, JA
目的：目前关于癌症老年患者自付医疗费用(OOPE)的信息有限。我们试图量化70岁或70岁以上社区居住个体的OOPE：1)没有癌症(无CA)，2)癌症病史，未接受当前治疗(CA/NO TX)，以及3)癌症病史，正在接受当前治疗(CA/TX)。方法：我们使用1995年资产与健康动力学研究的数据，这是一项具有全国代表性的社区老年人调查。受访者确定了他们的癌症状况，并报告了前两年的OOPE：1)住院和疗养院住宿，2)门诊服务，3)家庭护理，4)处方药。结果：在6370名受访者中，5382人(84%)报告没有CA，812人(13%)报告CA/NO TX，176人(3%)报告CA/TX。无CA、CA/NO TX和CA/TX组调整后的年平均OOPE分别为1210美元、1450美元和1880美元(P<；0.01)。处方药(每年1120美元)和家庭护理服务(250美元)占与癌症治疗相关的额外OOPE的大部分。接受癌症治疗的低收入个体在OOPE上的花费约占其年收入的27%，而没有癌症病史的高收入个体仅为年收入的5%(P<；.01)。结论：老年癌症治疗导致显著的OOPE，主要用于处方药和家庭护理服务。旨在预防和治疗癌症的经济评估和公共政策应该注意到美国老年癌症患者的重大OOPE。
Objective: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).Methods: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.Results: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were $1210, $1450, and $1880, respectively (P < .01). Prescription medications ($1120 per year) and home care services ($250) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01).Conclusions: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.