Health services utilization, out-of-pocket expenditure, and underinsurance among insured non-elderly cancer survivors in the United States, 2011-2015

Abstract

Background: High out-of-pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors.

Methods: We used 2011-2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non-elderly adult (age 18-64 years) cancer survivors. We used negative binomial, two-part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome.

Results: We identified 2738 insured non-elderly cancer survivors. Adjusted average utilization of ambulatory, non-ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non-Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non-ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service-specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured.

Conclusion: Many insured non-elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare-related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.

Keywords: cancer; health services; insurance; out-of-pocket expenditure.

FIGURE 1

Average services utilization per person per year by (A) demographic characteristics, (B) socioeconomic characteristics, among insured non‐elderly cancer survivors, 2011–2015. Estimates represent average adjusted prediction (AAP) from negative binomial model for each service type. Estimation models were adjusted for age, sex, race/ethnicity, marital status, income level, education, census region, insurance status, number of Medical Expenditure Panel Survey (MEPS) priority conditions, and self‐reported health status. Low income represents family income (FI) <200% of federal poverty level (FPL), middle income represents FI 200% to <400% of FPL, and high income represents FI ≥400% of FPL

FIGURE 2

Percent contribution of service‐specific out‐of‐pocket (OOP) expenditure to total OOP expenditure by sociodemographic characteristics, non‐elderly cancer survivors, 2011–2015. Low income represents family income (FI) <200% of federal poverty level (FPL), middle income represents FI 200% to <400% of FPL, and high income represents FI ≥400% of FPL