Medical Care Burden of Cancer: System and Data Issues

描述（由申请人提供）：癌症的总医疗费用约占全国医疗保健支出的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）癌症登记与医疗保险索赔（SEER- Medicare）。虽然SEER-Medicare联系代表了85%参加按服务收费（FFS）补偿方案的老年医疗保险受益人的经历，但该联系忽略了15%参加医疗保险hmo的老年人的经历。这些群体不同：1)HMO提供商面临不同的激励机制；2) HMO医保受益人普遍享有更好的福利；3)鉴于FFS与HMO的选择是自愿的，这两种人群的健康状况和偏好可能存在难以衡量的差异。此外，医疗保险工作年龄受益人的利用率和成本可能在SEER-Medicare中被低估。这些因素可能导致仅基于乙醚组的癌症成本估算的选择和遗漏偏差。在癌症研究网络的基础上，我们将开发一个多站点、多付款人的数据库，通过解决三个目标来支持分析，扩展和补充SEER-Medicare链接：估计所有癌症和选定癌症的增量医疗费用，按癌症部位、治疗阶段、诊断阶段、癌症类型（致死性与非致死性）、患者人口统计学、合并症和2000-2007年4个大型综合医疗保健系统的医疗费用来源进行分类。目标2 -遗漏偏差：估计老年医疗保险HMO受益人在SEER-Medicare中被遗漏的每个癌症治疗部分的成本：a)非医疗保险覆盖的服务；B) 65岁以前诊断出癌症的老年人的医疗保健的影响；C)癌症筛查服务；D)癌症预防服务；e)从私人医疗保险转向联邦医疗保险相关的福利变化（如果有的话）；f)雇主为工作年龄受益人提供的福利。目的3 -选择偏倚：估计所有癌症的增量医疗保健费用，以及选定的癌症，在2000-2007年的SEER-Medicare。对HMO和FFS系统中针对老年医疗保险受益人的癌症成本决定因素进行建模，纠正选择和遗漏偏差。我们假设HMO/FFS系统差异、利益差异和遗漏偏差将比选择偏差占更大的癌症成本比例。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。我们还将了解医疗保险的FFS和HMO选择之间的癌症治疗差异。

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.