THE PERSONAL FINANCIAL BURDEN OF CANCER IN THE U.S.: IMPLICATIONS FOR INSURANCE DESIGN

Purpose: To estimate the effect of cancer care on out-of-pocket (OOP) medical expenditures, employment, and work loss.

Methods: We pooled data from the 2000 through 2005 Medical Expenditure Panel Survey, a nationally representative survey of the civilian non-institutionalized population. The study sample was restricted to those of working age (ages 25 through 64) [N=89,520]. We constructed four groups for comparison: 1) persons who did not report having cancer (N=87,580) and, among those who reported having cancer, 2) persons with a claim for active cancer care (i.e., inpatient stay, chemotherapy, radiation, surgery, or prescription for antineoplastics) during the survey year (N=679), 3) persons with a claim for follow-up cancer care (N=968), and 4) persons with a history of cancer but without any cancer care (N=293). A two-part regression model was used to estimate the effect of being in the cancer treatment groups on OOP medical expenditures relative to not having cancer, controlling for potential confounders. A logistic model was used to estimate the effect of cancer treatment on the probability of being employed at some point in the survey year. Annual number of work days missed due to illness and injury was modeled using a negative binomial model.

Results: Compared to the population without cancer, annual OOP expenditures were $1,070 higher for those with active cancer treatment, $460 higher for those with follow-up cancer treatment, and $290 higher for those with cancer but no cancer treatment. Compared to not having cancer, active cancer treatment was associated with a 4.5% decrease in the probability of employment. For those who were employed, active cancer treatment was associated with 22.3 more work days missed per year compared to those without cancer.

Conclusions: The combination of increased OOP medical expenditures and potential for reduced earnings suggests that a diagnosis of cancer will lead to financial hardship at a time when an individual’s health and earning potential is most at risk. Changes to the current health system need to ensure that those diagnosed with cancer and other serious medical conditions will not be doubly burdened with poor health and high medical expenditures.