A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia

2021 ◽  
Vol 45 (2) ◽  
pp. 148
Author(s):  
Neli S. Slavova-Azmanova ◽  
Jade C. Newton ◽  
Claire E. Johnson ◽  
Harry Hohnen ◽  
Angela Ives ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Western Australia ◽  
Private Health Insurance ◽  
Cost Transparency ◽  
Cancer Centre ◽  
Rural Study ◽  
Out Of Pocket Expenses ◽  
Study Participants ◽  
Western Australian

ObjectiveTo determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. MethodsCross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. ResultsThe median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581–A$3769) and A$2855 (IQR: A$958–A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735–A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743–A$1951, P<0.001)). ConclusionThe cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic?In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add?This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners?First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.

scholarly journals The Determinants of Purchasing Private Health Insurance in Korean Cancer Patients

2007 ◽  
Vol 40 (2) ◽  
pp. 150 ◽  
Author(s):  
Jin Hwa Lim ◽  
Sung Gyeong Kim ◽  
Eun Mi Lee ◽  
Sin Young Bae ◽  
Jae Hyun Park ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Private Health Insurance

scholarly journals Catastrophic Health Expenditures and Its Inequality in Households with Cancer Patients: A Panel Study

Processes ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 39 ◽  
Author(s):  
Munjae Lee ◽  
Kichan Yoon
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Health Expenditure ◽  
Private Health Insurance ◽  
Transition Probability ◽  
Panel Study ◽  
Catastrophic Health Expenditure ◽  
Occurrence Rate ◽  
Logit Analysis ◽  
Healthcare Needs

This study aims to examine the determinants of catastrophic health expenditure in households with cancer patients by conducting a panel analysis of three-year data. Data are adopted from surveys administered by Korea Health Panel for 2012–2014. We conducted correspondence and conditional transition probability analyses to examine households that incurred catastrophic health expenditure, followed by a panel logit analysis. The analyses reveal three notable results. First, the occurrence of catastrophic health expenditure differs by age group, that is, the probability of incurring catastrophic health expenditure increases with age. Second, this probability is higher in households with National Health Insurance than those receiving medical care benefits. Finally, households without private health insurance report a higher occurrence rate. The findings suggest that elderly people with cancer have greater medical coverage and healthcare needs. Private health insurance contributes toward protecting households from catastrophic health expenditure. Therefore, future research is needed on catastrophic health expenditure with focus on varying age groups, healthcare coverage type, and private health insurance.

scholarly journals '…If I don't have that sort of money again, what happens?': adapting a qualitative model to conceptualise the consequences of out-of-pocket expenses for cancer patients in mixed health systems

2020 ◽  
Vol 44 (3) ◽  
pp. 355
Author(s):  
Jade C. Newton ◽  
Harry Hohnen ◽  
Claire E. Johnson ◽  
Angela Ives ◽  
Sandy McKiernan ◽  
...  
Keyword(s):  
Health System ◽  
Cancer Treatment ◽  
Coping Strategies ◽  
Cancer Patients ◽  
Healthcare System ◽  
Economic Consequences ◽  
Health Providers ◽  
Health Practitioners ◽  
Out Of Pocket Expenses ◽  
Western Australian

ObjectiveThe aim of this study was to explore Western Australian cancer patients’ experiences of out-of-pocket expenses (OOPE) during diagnosis and cancer treatment using a phenomenological approach. MethodsSemi-structured interviews were conducted with a purposive convenience sample of 40 Western Australian cancer patients diagnosed with breast, lung, prostate or colorectal cancer. Participants were asked about the impact of their diagnosis, the associated costs and their experience within the health system. Data were analysed using thematic content analysis. ResultsThree key themes influencing participant OOPE experiences were identified: (1) personal circumstances; (2) communication with health providers; and (3) coping strategies. Despite Australia’s public healthcare system, several participants found the costs affected their financial security and resorted to coping strategies including medication rationing and restrictive household budgeting. The key themes had a complex and interrelated effect on patient OOPE experiences and were used to adapt Carrera et al.’s model of economic consequences of cancer treatment on the patient and patient coping to describe these relationships in a mixed healthcare system. ConclusionOrganised efforts must be implemented to mitigate maladaptive coping strategies being used by cancer patients: (1) health providers should seek informed financial consent from patients before commencing treatment; and (2) financial aid and support schemes for cancer patients should be reviewed to ensure they are delivered equitably. What is known on this topic?The financial cost of cancer can have significant adverse effects on cancer patients. Although financial transparency is desired by cancer patients, its implementation in practice is not clear. What does this paper add?This study adapts a conceptual model for the economic consequences of a cancer diagnosis and repurposes it for a mixed public–private health system, providing a framework for understanding downstream consequences of cancer costs and highlighting opportunities for intervention. What are the implications for health practitioners?Health practitioners need to initiate discussions concerning treatment costs earlier with cancer patients. There are several resources and guides available to assist and facilitate financial transparency. Without urgent attention to the financial consequences of cancer treatment and related expenses, we continue to leave patients at risk of resorting to maladaptive coping strategies, such as medication rationing and restrictive household budgeting.

scholarly journals The influence of socio-economic and locational disadvantage on patterns of surgical care for lung cancer in Western Australia 1982-2001

2004 ◽  
Vol 27 (2) ◽  
pp. 68 ◽  
Author(s):  
Sonya E Hall ◽  
C D'arcy Holman ◽  
Harry Sheiner
Keyword(s):  
Lung Cancer ◽  
Health Insurance ◽  
Population Health ◽  
Western Australia ◽  
Private Health Insurance ◽  
Lung Cancer Surgery ◽  
Surgical Care ◽  
Cancer Surgery ◽  
The University ◽  
To Receive

Sonja E Hall is with the School of Population Health, The University of Western Australia.C D'Arcy J Holman is Head, School of Population Health, The University of Western Australia.Harry Sheiner is Chairman, WA Clinical Oncology Group, c/o Cancer Foundation of Western Australia.Objective: Patterns of in-hospital surgical care for lung cancer in Western Australia were examined, including the effects of demographic, locational and socio-economic disadvantage and the possession of private health insurance, on the likelihood of receiving surgeryPatients and methods: The WA Record Linkage Project was used to extract hospital morbidity, cancer and death records of all people with lung cancer in Western Australia from 1982 to 2001. The likelihood of receiving lung cancer surgery was estimated, after adjustment for co-variates, using logistic regression.Results: Overall, 16% of patients received surgery for their lung cancer, although this varied according to histology. Patients who received surgery were typically younger, female, non-indigenous and had less comorbidity. Patients from socio-economically disadvantaged groups tended to be less likely to receive surgery (OR 0.79; 95% CI 0.61-1.04) although this was not significant for each category of disadvantage. Those who had their first hospital admission, with a mention of lung cancer, in a rural hospital were less likely to receive surgery (OR 0.26; 95% CI 0.19-0.36) than those in metropolitan hospitals, although residential location generally had less effect (OR 0.36; 95% CI 0.14-0.92). Patients admitted as a private patient either to a private or public hospital for their first mention of lung cancer had increased likelihood of receiving surgery (OR 1.15; 95% CI 1.02-1.30); however first admission to a private hospital had no effect (OR 0.99: 95% CI 0.85-1.16).Conclusion: The utilisation of lung cancer surgery was low with several factors found to affect the rate. Patients from socio-economically or locationally disadvantaged backgrounds, indigenous patients or patients without private health insurance were less likely to receive lung cancer surgery than those from more advantaged groups.

scholarly journals Out-of-pocket medical expenses compared across five years for patients with one of five common cancers in Australia

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Astrid J. Rodriguez-Acevedo ◽  
Raymond J. Chan ◽  
Catherine M. Olsen ◽  
Nirmala Pandeya ◽  
David C. Whiteman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Medical Services ◽  
Cancer Type ◽  
Medical Expenses ◽  
Patients With Cancer ◽  
Out Of Pocket Expenses ◽  
Over Time

Abstract Background Patient medical out-of-pocket expenses are thought to be rising worldwide yet data describing trends over time is scant. We evaluated trends of out-of-pocket expenses for patients in Australia with one of five major cancers in the first-year after diagnosis. Methods Participants from the QSKIN Sun and Health prospective cohort Study with a histologically confirmed breast, colorectal, lung, melanoma, or prostate cancer diagnosed between 2011 and 2015 were included (n = 1965). Medicare claims data on out-of-pocket expenses were analysed using a two-part model adjusted for year of diagnosis, health insurance status, age and education level. Fisher price and quantity indexes were also calculated to assess prices and volumes separately. Results On average, patients with cancer diagnosed in 2015 spent 70% more out-of-pocket on direct medical expenses than those diagnosed in 2011. Out-of-pocket expenses increased significantly for patients with breast cancer (mean AU$2513 in 2011 to AU$6802 in 2015). Out-of-pocket expenses were higher overall for individuals with private health insurance. For prostate cancer, expenses increased for those without private health insurance over time (mean AU$1586 in 2011 to AU$4748 in 2014) and remained stable for those with private health insurance (AU$4397 in 2011 to AU$5623 in 2015). There were progressive increases in prices and quantities of medical services for patients with melanoma, breast and lung cancer. For all cancers, prices increased for medicines and doctor attendances but fluctuated for other medical services. Conclusion Out-of-pocket expenses for patients with cancer have increased substantially over time. Such increases were more pronounced for women with breast cancer and those without private health insurance. Increased out-of-pocket expenses arose from both higher prices and higher volumes of health services but differ by cancer type. Further efforts to monitor patient out-of-pocket costs and prevent health inequities are required.

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