Browsing Theses and Dissertations School of Pharmacy by Author "Ke, Xuehua"
Supplemental Insurance and Health Care Utilization and Spending among Elderly Cancer SurvivorsKe, Xuehua; Davidoff, Amy J., 1957-; Stuart, Bruce C. (2014)Little is known about the impact of complex interactions of financial resources, health status, and attitudes towards health care seeking upon access to and utilization of health care beyond the acute cancer diagnosis and treatment phases. The study examined the relationship between supplemental medical and prescription insurance and use and spending on selected health care services for elderly Medicare cancer survivors compared to non-cancer controls. Data were pooled from the 1997-2007 Medicare Current Beneficiary Survey (MCBS) including linked historical and concurrent claims. A cancer survivorship year was randomly selected from one of the MCBS years that met the following criteria: (1) being post cancer-diagnosis year 2 or later, (2) no active treatment, and (3) no enrollment in hospice, or death, and with complete Cost and Use survey data available. The observation year for non-cancer controls was randomly selected from one of the MCBS years meeting the selection criteria (3). Spending was adjusted to 2007 dollars. Univariate and bivariate analyses were used to describe sample baseline characteristics. Naive generalized linear models and two-stage residual inclusion methods were conducted to examine whether there is a differential effect of supplemental insurance on health care utilization and spending for cancer survivors vs. non-cancer controls. The study included 3,958 cancer survivors and 7,056 non-cancer controls. Breast (21%), prostate (21%), and colorectal (16%) were the three most common cancer sites among cancer survivors. The study showed that cancer survivors had generally higher socioeconomic status, were more likely to have supplemental insurance, had more comorbidities, and had stronger preferences for medical care than non-cancer controls. Cancer survivors tended to use more selected preventive services and had higher total healthcare and prescription drugs spending, while use less recommended medications for diabetes than non-cancer controls. In the main multivariate analyses, supplemental insurance had an effect on use and spending on selected health care services, but had no differential effect for cancer survivors vs. non-cancer controls. The results help fill a gap in understanding the relationship of supplemental insurance to health care utilization and spending for elderly Medicare cancer survivors.