Trends in Obesity and Medical Expenditure among Women with Diabetes, 2008-2016: Differences by Race/Ethnicity

Types of usual sources of care and their association with healthcare outcomes among cancer survivors: a Medical Expenditure Panel Survey (MEPS) study

PURPOSE

To assess associations between usual source of care (USC) type and health status, healthcare access, utilization, and expenses among adult cancer survivors.

METHODS

This retrospective cross-sectional analysis using 2013-2018 Medical Expenditure Panel Survey included 2690 observations representing 31,953,477 adult cancer survivors who were currently experiencing cancer and reporting one of five USC types: solo practicing physician (SPP), a specific person in a non-hospital facility, a specific person in a hospital-based facility, a non-hospital facility, and a hospital-based facility. We used logistic regressions and generalized linear models to determine associations of USC type with health status, healthcare access, utilization, and expenses, adjusting for patient demographic and clinical characteristics.

RESULTS

All non-SPP USC types were associated with reporting more difficulties contacting USC by telephone during business hours (p < 0.05). Compared to SPP, non-hospital facility was associated with more difficulty getting needed prescriptions (OR: 1.81, p = 0.036) and higher annual expenses ($5225, p = 0.028), and hospital-based facility was associated with longer travel time (OR: 1.61, p = 048), more ED visits (0.13, p = 0.049), higher expenses ($6028, p = 0.014), and worse self-reported health status (OR: 1.93, p = 0.001), although both were more likely to open on nights/weekends (p < 0.05). Cancer survivors with a specific person in a hospital-based facility (vs. SPP) as USC were > twofold as likely (p < 0.05) to report difficulty getting needed prescriptions and contacting USC afterhours.

CONCLUSIONS

Among adult cancer survivors who were currently experiencing cancer, having a non-SPP type of UCS was associated with reporting more difficulties accessing care, worse health, more ED visits, and higher total expenses.

IMPLICATIONS FOR CANCER SURVIVORS

Transitioning to SPP type of USC may result in better healthcare outcomes.

Trends in Healthcare Expenditures among Adults in the United States by Cancer Diagnosis Status, 2008-2016: A Cross Sectional Study

BACKGROUND

This study aims to assess trends in direct medical expenditures and indirect costs between adults with and without a prior cancer diagnosis from 2008-2016.

METHODS

Nine years of data (2008-2016) from the Medical Expenditure Panel Survey (weighted N=236,811,875) were used. The outcomes included medical expenditures (total expenditure, inpatient, office-based, medications, outpatient, dental, emergency room visits, home health, other) and health-related missed workdays. The predictor was prior cancer diagnosis. Covariates included demographic characteristics, comorbidities, and calendar year at time of survey completion. Two-part statistical modeling with a combination of binomial and positive distributions was used to estimate medical expenditures and missed workdays. Data were clustered into five timepoints: 2008-2009, 2010-2011, 2012-2013, 2014-2015, and 2016.

RESULTS

Eleven percent of the sample (n=25,005,230) had a prior cancer diagnosis. Compared to those without a prior cancer diagnosis, those with a prior cancer diagnosis had higher mean incremental total expenditures across all years. Between 2008-2016, the adjusted annual incremental total expenditures were $3,522 (95%CI $3,072, $3,972); office-based visits ($1,085;95% CI $990, $1180); inpatient hospitalizations ($810;95%CI $627, $992); outpatient appointments ($517;95%CI $434, $600); and medications ($409;95%CI $295, $523); and health-related missed workdays (0.75;95%CI 0.45, 1.04) compared to adults without a prior cancer diagnosis.

CONCLUSIONS

Adults with a prior cancer diagnosis had significantly increased healthcare expenditures and health-related missed workdays compared to those with no cancer diagnosis.

IMPACT

Our findings highlight the need for increasing strategies to remedy the impact of increasing direct and indirect costs associated with cancer survivorship as the population grows and ages.

Early Stage Investigators: Emerging Research Supporting Health Equity

Ethn Dis. 2020;30(4):517-518; doi:10.18865/ed.30.4.517