Medical Care Burden of Cancer: System and Data Issues

癌症的总医疗费用约占国家医疗保健支出的5%和医疗保险支出的10%。我们对癌症费用的了解大部分来自国家癌症研究所的监测、流行病学和最终结果（SEER）癌症登记处与医疗保险索赔（SEER-医疗保险）的联系。虽然SEER-医疗保险链接代表了85%参加按服务收费（FFS）赔偿选项的老年医疗保险受益人的经验，但该链接忽略了15%参加医疗保险HMO的老年人的经验。这些群体不同：1）HMO提供者面临不同的激励措施; 2）HMO医疗保险受益人通常有更好的福利; 3）鉴于FFS与HMO的选择是自愿的，这两个人群的健康状况和偏好可能会有所不同，难以衡量。此外，医疗保险工作年龄受益人的利用率和成本可能在SEER-医疗保险中报告不足。这些因素可能会导致选择和遗漏的癌症成本估计的基础上醚组单独的偏差。在癌症研究网络的基础上，我们将开发一个多站点，多付款人数据库，以支持通过解决3个目标扩展和补充SEER-医疗保险链接的分析：目标1 -描述性分析：估计所有癌症和选定癌症的增量医疗保健成本，按癌症部位、治疗阶段、诊断阶段、癌症类型细分（致命性与非致命性）、患者人口统计学资料、合并症和2000-2007年4个大型综合卫生保健系统的健康保险来源。目标2 -遗漏偏差：估计SEER-Medicare中遗漏的老年医疗保险HMO受益人的每个癌症护理组成部分的成本：a）非Medicare覆盖的服务; B）65岁之前诊断出癌症的老年人的医疗保健影响; c）癌症筛查服务; d）癌症预防服务; e）与从私人健康保险转向Medicare相关的福利变化（如果有）;（f）为工作年龄受益人提供的雇主覆盖的福利。目标3 -选择偏差：估计2000-2007年SEER-Medicare所有癌症以及选定癌症的增量医疗保健成本。为医疗保险老年受益人建立HMO和FFS系统中癌症成本决定因素的模型，纠正选择和遗漏偏差。我们假设HMO/FFS系统差异、受益差异和遗漏偏差将比选择偏差占癌症成本的更大比例。这项研究将更新老年医疗保险受益人癌症医疗费用的信息。我们还将了解癌症护理在Medicare的FFS和HMO选项之间的差异。

DESCRIPTION (provided by applicant): The total medical costs of cancers are about 5% of national health care expenditures and 10% of Medicare outlays. Much of what we know about cancer costs comes from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registries linked to Medicare claims (SEER- Medicare). While the SEER-Medicare link represents the experience of 85% of Aged Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, the link omits the experience of the 15% of seniors enrolled in Medicare HMOs. These groups differ: 1) HMO providers face different incentives; 2) HMO Medicare beneficiaries generally have better benefits; 3) given that FFS vs. HMO choice is voluntary, the 2 populations may differ in their health status and preferences in ways that are difficult to measure. In addition, utilization and costs for Medicare Working Aged beneficiaries may be under-reported in SEER-Medicare. These factors may cause selection and omission biases in cancer cost estimates based on ether group alone. Building on the Cancer Research Network, we will develop a multi-site, multi-payer database to support analyses extending and complementing the SEER-Medicare link by addressing 3 aims: Aim 1 - Descriptive Analyses: Estimate the incremental medical care cost of all cancers, and selected cancers, broken down by cancer site, phase of treatment, stage at diagnosis, cancer type (fatal vs. non- fatal), patient demographics, co-morbidity, and source of health insurance for the years 2000-2007 in 4 large integrated health care systems. Aim 2 - Omissions Bias: Estimate the costs of each cancer care component for Aged Medicare HMO beneficiaries that is omitted from SEER-Medicare: a) non-Medicare covered services; b) effects of health care for seniors whose cancers were diagnosed before age 65; c) cancer screening services; d) cancer prevention services; e) changes in benefits, if any, associated with switching from private health insurance to Medicare; and f) employer-covered benefits for Working Aged beneficiaries. Aim 3 - Selection Bias: Estimate the incremental medical care costs of all cancers, as well as selected cancers, for SEER-Medicare over 2000-2007. Model the determinants of cancer costs across HMO and FFS systems for Medicare Aged beneficiaries, correcting for selection and omissions biases. We hypothesize that HMO/FFS system differences, benefit differences, and omissions biases will account for a larger proportion of cancer costs that those from selection biases. This study will update the information on the medical care costs of cancer for Aged Medicare beneficiaries. We will also learn how cancer care varies between Medicare's FFS and HMO options.