title: There is a mismatch between the medicare benefit package and the preferences of patients with cancer and their caregivers.
abstract: OBJECTIVE
  To identify insured services that are most important to Medicare beneficiaries with cancer and their family caregivers when coverage is limited.
  
  
  METHODS
  A total of 440 participants (patients, n = 246; caregivers, n = 194) were enrolled onto the CHAT (Choosing Health Plans All Together) study from August 2010 to March 2013. The exercise elicited preferences about what benefits Medicare should cover for patients with cancer in their last 6 months of life. Facilitated sessions lasted 2.5 hours, included 8 to 10 participants, and focused on choices about Medicare health benefits within the context of a resource-constrained environment.
  
  
  RESULTS
  Six of 15 benefit categories were selected by > 80% of participants: cancer care, prescription drugs, primary care, home care, palliative care, and nursing home coverage. Only 12% of participants chose the maximum level of cancer benefits, a level of care commonly financed in the Medicare program. Between 40% and 50% of participants chose benefits not currently covered by Medicare: unrestricted cash, concurrent palliative care, and home-based long-term care. Nearly one in five participants picked some level of each of these three benefit categories and allocated on average 30% of their resources toward them.
  
  
  CONCLUSIONS
  The mismatch between covered benefits and participant preferences shows that addressing quality of life and the financial burden of care is a priority for a substantial subset of patients with cancer in the Medicare program. Patient and caregiver preferences can be elicited, and the choices they express could suggest potential for Medicare benefit package reform and flexibility.
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD. don.taylor@duke.edu.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Lynn J
authors.initials: LJ
authors.lastname: Howie
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Samsa
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Wolf
authors.affiliation: Donald H. Taylor Jr, Sanford School of Public Policy, Duke University; S. Yousuf Zafar, Lynn J. Howie, and Amy P. Abernethy, Duke Clinical Research Institute; Gregory P. Samsa and Steven P. Wolf, Duke University Medical Center, Durham, NC; and Marion Danis, National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D057240:Patient Preference; D011788:Quality of Life; D014481:United States