Access to care for older cancer survivors: Impacts of Medicare and supplemental insurance coverage

项目摘要/摘要 有越来越多的老年癌症幸存者有持续的医疗保健需求 来自癌症、癌症治疗和其他并发症的持久影响。全中国癌症幸存者中的 美国人的年龄在65岁及以上，这使得医疗保险成为癌症幸存者护理的最大支付者。尽管 尽管医疗保险在癌症幸存者中无处不在，但医疗保险对获得医疗服务的影响尚未得到 经过广泛研究。此外，几乎没有证据表明医疗服务的可及性和可负担性在不同国家和地区之间存在差异 是癌症幸存者的医疗保险受益人。医疗保险的高成本分担可能会给医疗保健带来障碍 然而，在癌症幸存者中，个人面临这些成本的程度取决于补充 保险公司。因此，这项提案的目标是分析医疗保险的可用性和水平如何 承保范围(基于补充保险)影响癌症幸存者获得护理的机会。 拟议的研究将利用丰富的全国调查数据来填补这些证据空白，以评估 老年癌症幸存者的医疗保险覆盖范围和补充保险的影响 获得护理的途径。AIM 1将使用国家健康访谈调查(NHIS)来调查符合条件的 联邦医疗保险影响自我报告的获取成本障碍，利用65岁时发生的覆盖范围突然变化 在回归不连续设计中。目标2将广泛地检查获得护理的机会如何根据不同的水平而不同 医疗保险范围内的补充覆盖，使用患者报告的医疗保健准入和 与Medicare当前受益人补充保险覆盖范围的详细数据相关联的可负担性 调查(MCBS)。AIM 3将使用MCBS来评估医疗补助补充覆盖的效果， 覆盖社会经济地位较低的医疗保险受益人-包括不成比例的种族和 少数民族--关于获得护理的问题。目标3专门探讨了补充医疗补助的这些影响 通过利用医疗补助中的突然差异覆盖(通过合格的联邦医疗保险受益人计划) 使用回归不连续设计100%符合联邦贫困线的资格。 这些目标加在一起，将为医疗保险覆盖范围的影响和 在老年癌症幸存者获得护理的情况下，在医疗保险中提供补充保险。建议的调查结果 研究将为正在考虑的使医疗保险可及(例如，降低资格)的提案提供信息 年龄)和负担得起(例如，限制或取消费用分担或扩大医疗补助补充覆盖范围)， 有意义地推进AHRQ的目标，即提供证据，使卫生保健可获得、负担得起和 公平。这项工作还包括AHRQ的多个优先人群，包括老年人、低收入者、 少数族裔，以及患有严重并存疾病的人。

PROJECT SUMMARY/ABSTRACT There is a growing population of older adult cancer survivors who have ongoing health care needs that stem from the lasting effects of cancer, cancer treatment, and other comorbidities. Fully 64% of cancer survivors in the US are ages 65 and older, making Medicare the largest payer for cancer survivorship care. Despite the ubiquity of Medicare coverage among cancer survivors, the effects of Medicare on access to care are yet to be extensively studied. There is also little evidence about how access to and affordability of care varies among Medicare beneficiaries who are cancer survivors. Medicare’s high cost-sharing may present barriers to care among cancer survivors, yet the extent to which individuals face these costs varies based on supplemental insurance. Therefore, the goal of this proposal is to analyze how the availability and levels of Medicare coverage (based on supplemental insurance) impact cancer survivors’ access to care. The proposed study will fill these evidence gaps using rich national survey data to evaluate the effects of Medicare coverage and the effects of supplemental insurance within Medicare on older adult cancer survivors’ access to care. Aim 1 will use the National Health Interview Survey (NHIS) to investigate how eligibility for Medicare affects self-reported cost barriers to access, exploiting abrupt coverage changes that occur at age 65 in a regression discontinuity design. Aim 2 will broadly examine how access to care differs by levels of supplemental coverage within Medicare, using patient-reported measures of health care access and affordability linked to detailed data on supplemental insurance coverage in the Medicare Current Beneficiary Survey (MCBS). Aim 3 will use the MCBS to evaluate the effects of Medicaid supplemental coverage, which covers Medicare beneficiaries of low socioeconomic status—including a disproportionate share of racial and ethnic minorities—on access to care. Aim 3 specifically explores these effects of Medicaid supplemental coverage (via the Qualified Medicare Beneficiary program) by exploiting an abrupt difference in Medicaid eligibility at 100% of the Federal Poverty Line using a regression discontinuity design. Together, these aims will provide novel evidence about the effects of Medicare coverage and variations in supplemental insurance within Medicare on older cancer survivors’ access to care. Findings from the proposed research will inform proposals under consideration to make Medicare accessible (e.g., lowering the eligibility age) and affordable (e.g. limiting or eliminating cost-sharing or expanding Medicaid supplemental coverage), meaningfully advancing AHRQ’s goal to produce evidence to make health care accessible, affordable, and equitable. This work is also inclusive of multiple AHRQ priority populations, including the elderly, low-income, racial/ethnic minorities, and those with severe comorbidities.