Medical Care Burden of Cancer: System and Data Issues

描述(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%，占医疗保险支出的10%。我们对癌症费用的大部分了解来自国家癌症研究所的监测、流行病学和最终结果(SEER)与医疗保险索赔相关的癌症登记(SEER-Medicare)。虽然SEER-Medicare链接代表了85%参加按服务收费(FFS)赔偿选项的老年Medicare受益人的经历，但该链接忽略了参加Medicare HMO的15%老年人的经历。这些群体不同：1)HMO提供者面临不同的激励；2)HMO Medicare受益人通常有更好的福利；3)鉴于FFS和HMO的选择是自愿的，这两个群体的健康状况和偏好可能以难以衡量的方式存在差异。此外，在SEER-Medicare中，联邦医疗保险工作年龄受益人的利用率和费用可能会被低估。这些因素可能会导致仅基于乙醚基团的癌症成本估计中的选择和遗漏偏差。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，以支持扩展和补充SEER-Medicare联系的分析，以满足3个目标：目标1-描述性分析：估计2000-2007年4个大型综合保健系统中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(致命与非致命)、患者人口统计、合并发病率和医疗保险来源进行细分。目的2--疏漏偏差：估计SEER-Medicare中遗漏的老年Medicare 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)对65岁之前被诊断为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)与从私人医疗保险转向Medicare相关的福利变化(如果有)；以及f)雇主覆盖的老年受益人福利。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费用。为老年医疗保险受益人的HMO和FFS系统中的癌症成本决定因素建模，修正选择和遗漏偏差。我们假设，HMO/FFS系统差异、受益差异和遗漏偏差将占癌症成本的更大比例，而不是来自选择偏差。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联邦医疗保险的FFS和HMO选项之间有何不同。

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.