Abstract 4340: Out-of-pocket expenditure, probability of underinsurance and health services utilization among non-elderly cancer survivors
Authors: Karim Mohammad , Ohsfeldt Robert L. , Singal Amit G. , Kum Hye-Chung 
Published: September 2020

Abstract
Background: Financial burden among cancer survivors by type of health services utilized is an under-explored topic. We estimated health services utilization, out-of-pocket (OOP) expenditure, and underinsurance for a large cohort of cancer survivors. Methods: We used Medical Expenditure Panel Survey (MEPS) Household component (2011-2015) and accounted for MEPS survey design. Underinsurance was defined as OOP≥5% of family income (FI) for FI&lt;200% of federal poverty level (FPL) or ≥10% of FI for FI≥200% of FPL, for full year insured individuals. We identified cancer survivors using Clinical Classifications Software (CCS) codes and excluded uninsured or intermittently insured (n=2738). OOP, underinsurance and utilization were estimated using two-part regression (logistic and GLM), logistic regression, and negative binomial regression models respectively. Average Adjusted Prediction (AAP) and Average Marginal Effect (AME) measures were used to quantify all estimates. Predictors in the models were: age, sex, race/ethnicity, marital status, education, income (excluded in underinsurance model), insurance status, number of comorbid conditions, health status and census region (all categorical variables). Service categories analyzed were: ambulatory (office based + outpatient), non-ambulatory (inpatient + ER), prescription medication, dental care and other services. Results: The category-wise services utilization and OOP analysis revealed that patients aged 60-64 years utilize (1.59 vs. 1.16 events, p&lt;0.01) and spend more ($239 vs. $146, p&lt;0.05) on dental services vs. those aged 18-49 years; females utilize (16 vs. 12 events, p&lt;0.01) and spend more ($768 vs. $575, p&lt;0.05) on ambulatory services vs. males; Blacks and Asians utilize (21 and 21 vs. 26 events, p&lt;0.01 and p&lt;0.05 respectively) and spend less ($298 and $288 vs. $479, p&lt;0.01 for both) on prescriptions vs. Whites; and patients with a college degree utilize (16 vs. 12 events, p&lt;0.01) and spend more ($827 vs. $561, p&lt;0.01) on ambulatory services vs. those with less education. Medicare-only insurance was associated with higher prescription OOP. Underinsurance was significantly higher in older patients and lower among Blacks and married patients (Table 1). Conclusion: Subgroups of non-elderly cancer survivors utilize several health services at significantly higher levels than their counterparts, resulting in underinsurance and high OOP cost.
Table 1:Probability of underinsurance by sociodemographicsFactorLevelProb. of Underinsurance %)page range18-49 [ref.]750-5990.16960-64130.000race/ethnicitywhite [ref.]10black50.001hispanic100.961asian/others60.135marital statusnor married [ref.]16married60.000
Citation Format: Mohammad Karim, Robert L. Ohsfeldt, Amit G. Singal, Hye-Chung Kum. Out-of-pocket expenditure, probability of underinsurance and health services utilization among non-elderly cancer survivors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4340.