背景:在美国,由于癌症治疗的昂贵性质和增加的成本分担责任,被诊断患有癌症的医疗保险受益人通常面临重大的财务挑战。然而,在COVID-19大流行期间,与传统的按服务付费医疗保险(TM)相比,医疗保险优势(MA)参保人员面临的财务困难和医疗保健利用方面的知识有限。我们的研究旨在调查参加TM和MA的个人所经历的主观财务困难,并确定这两个Medicare计划在大流行期间是否在医疗保健利用方面存在差异。
方法:我们利用了2020-2022年全国健康访谈调查(NHIS)的数据,重点关注65岁或以上的癌症幸存者的全国代表性样本。财务困难被分为三个不同的组:材料(例如,医疗账单问题),心理(例如,担心付款),和行为(例如,因费用原因延迟护理)。医疗保健利用包括健康访问(预防性护理),紧急护理服务,住院治疗,和远程健康。我们使用调查设计调整分析来比较MA和TM之间的研究结果。
结果:在440万患有癌症的Medicare受益人的加权样本中(平均年龄:74.9),76%的人参加了MA计划。拥有大学学位的癌症幸存者(59.3%vs.49.8%)和高家庭收入(38.2%与31.1%)更有可能参加MA计划。任何材料都没有显著差异,心理,或MA和TM计划的受益人之间的行为财务困难领域,但由于成本原因放弃了咨询。对于医疗保健利用措施,MA的癌症幸存者比TM的幸存者更有可能接种流感疫苗(77.2%vs.70.1%)和住院率较低(16.0%vs.20.0%)。然而,MA和TM在其他卫生服务利用方面没有差异。
结论:虽然在任何物化中都没有观察到显著差异,心理,或者行为财务困难,参加MA计划的年龄较大的癌症幸存者在COVID-19期间更有可能接受疫苗接种,住院率更低.尽管其他预防性或初级保健就诊(即,健康访问)更高,他们的差异没有达到统计学意义。随着MA越来越受欢迎,在我们驾驭大流行后的环境时,必须持续监测和评估针对癌症幸存者的Medicare计划的绩效和结果。
BACKGROUND: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic.
METHODS: We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM.
RESULTS: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM.
CONCLUSIONS: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.