National estimates of out-of-pocket health care expenditure burdens among nonelderly adults with cancer: 2001 to 2008

Abstract

Purpose: To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer.

Methods: The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums).

Results: The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions.

Conclusion: High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.

Fig 1.

Prevalence of high total burdens among nonelderly adults by medical condition and age. Calculations using the Medical Expenditure Panel Survey–Household Component, 2001 to 2008. Total burden includes out-of-pocket expenditures on health insurance premiums and health care services for all family members. (*) Difference from the reference category (cancer) is significant at the 1% level.

Fig 2.

Prevalence of high total burdens among nonelderly adults by medical condition and insurance status. Calculations using the Medical Expenditure Panel Survey–Household Component, 2001 to 2008. Total burden includes out-of-pocket expenditures on health insurance premiums and health care services for all family members. (*) Difference from the reference category (cancer) is significant at the 5% level. (†) Difference from the reference category (cancer) is significant at the 1% level.

Fig 3.

Prevalence of high out-of-pocket burdens among nonelderly adults receiving treatment for cancer by insurance status. Calculations using the Medical Expenditure Panel Survey–Household Component, 2001 to 2008. Health care burden includes out-of-pocket expenditures on health insurance premiums and health care services for all family members. (*) Difference from the reference category (private group) is significant at the 1% level.

Fig 4.

Mean out-of-pocket expenditures by service type among nonelderly adults receiving treatment for cancer by insurance status. Calculations using the Medical Expenditure Panel Survey–Household Component, 2001 to 2008. Health care burden includes out-of-pocket expenditures on health insurance premiums and health care services for all family members. (*) Difference from the reference category (private group) is significant at the 5% level. (†) Difference from the reference category (private group) is significant at the 1% level.

Fig 5.

Prevalence of high total burdens among cancer survivors receiving and not receiving treatment for cancer. Calculations using the National Health Interview Survey–Medical Expenditure Panel Survey linked sample, 2001 to 2008. Total burden includes out-of-pocket expenditures on health insurance premiums and health care services for all family members. Sample size was too small to make reliable estimates for cancer survivors with private nongroup insurance who were not receiving treatment. (*) Difference from the reference category (cancer survivor receiving treatment) is significant at the 5% level. (†) Difference from the reference category (cancer survivor receiving treatment) is significant at the 1% level.