title: Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer.
abstract: BACKGROUND
  There is increasing concern regarding the financial burden of care on cancer patients and their families. Medicare beneficiaries often have extensive comorbidities and limited financial resources, and may face substantial cost sharing even with supplemental coverage. In the current study, the authors examined out-of-pocket (OOP) spending and burden relative to income for Medicare beneficiaries with cancer.
  
  
  METHODS
  This retrospective, observational study pooled data for 1997 through 2007 from the Medicare Current Beneficiary Survey linked to Medicare claims. Medicare beneficiaries with newly diagnosed cancer were selected using claims-based diagnoses. Generalized linear models were used to estimate OOP spending. Logistic regression models identified factors associated with a high OOP burden, defined as spending > 20% of one's income during the cancer diagnosis and subsequent year.
  
  
  RESULTS
  The cohort included 1868 beneficiaries with and 10,047 without cancer. Compared with the noncancer cohort, cancer patients were older, had more comorbidities, and were more likely to lack supplemental coverage. The mean OOP spending for cancer patients was $4727. Cancer patients faced an adjusted $976 (P < .01) incremental OOP spending. Greater than one-quarter (28%) of beneficiaries with cancer experienced a high OOP burden compared with 16% of beneficiaries without cancer (P < .001). Supplemental insurance and higher income were found to be protective against a high OOP burden, whereas assets, comorbidity, and receipt of cancer-directed radiation and antineoplastic therapy were associated with a higher OOP burden.
  
  
  CONCLUSIONS
  Medicare beneficiaries with cancer face a higher OOP burden than their counterparts without cancer; some of the higher burden was explained by the higher comorbidity burden and lack of supplemental insurance noted among these patients. Financial pressures may discourage some elderly patients from pursuing treatment.
authors.affiliation: Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA. adavidof@rx.umaryland.edu
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Mujde
authors.initials: M
authors.lastname: Erten
authors.forename: Thomas
authors.initials: T
authors.lastname: Shaffer
authors.forename: J Samantha
authors.initials: JS
authors.lastname: Shoemaker
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.forename: Naimish
authors.initials: N
authors.lastname: Pandya
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Tai
authors.forename: Xuehua
authors.initials: X
authors.lastname: Ke
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007349:Insurance, Health, Reimbursement; D008297:Male; D006278:Medicare / Q000191:economics*; D009369:Neoplasms / Q000191:economics*; D012189:Retrospective Studies; D014481:United States