Rural‐Urban Differences in Costs of End‐of‐Life Care for Elderly Cancer Patients in the United States

Journal of Rural Health - Tập 32 Số 4 - Trang 353-362 - 2016
Hongmei Wang1, Fang Qiu2, Eugene Boilesen3, Preethy Nayar1, Lina Lander4, Kate Watkins5, Shinobu Watanabe‐Galloway4
1Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
3Center for Collaboration on Research Design and Analysis College of Public Health University of Nebraska Medical Center Omaha Nebraska
4Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
5El Paso County Public Health, Communicable Disease Program, Colorado Springs, Colorado

Tóm tắt

AbstractPurposeThe objective of this study was to examine the rural‐urban differences in Medicare expenditures on end‐of‐life care for elderly cancer patients in the United States.MethodsWe analyzed Medicare claims data for 175,181 elderly adults with lung, colorectal, female breast, or prostate cancer diagnosis who died in 2008. The end‐of‐life costs were quantified as total Medicare expenditures for the last 12 months of care including inpatient, outpatient, physician services, hospice, home health, skilled nursing facilities (SNF), and durable medical expenditure. Linear regression models were used to estimate rural‐urban differences in log‐transformed end‐of‐life costs and logistic regressions were used to estimate probability of service use, adjusting for demographics, socioeconomic status, and comorbidities.FindingsOn average, elderly cancer patients cost Medicare $51,273, $50,274, $62,815, and $50,941 in the last year for breast, prostate, colorectal, and lung cancer, respectively. Rural patients cost Medicare about 10%, 6%, 8%, and 4% less on end‐of‐life care than their urban counterparts for breast, prostate, colorectal, and lung cancer, respectively. Rural cancer patients were less likely to use hospice and home health, more likely to use outpatient and SNF, and they cost Medicare less on inpatient and physician services and more on outpatient care conditional on service use.ConclusionsThe lower Medicare spending on end‐of‐life care for the rural cancer patients suggests disparities based on place of residence. A future study that delineates the source of the rural‐urban difference can help us understand whether it indicates inappropriate level of palliative care and find effective policies to reduce the urban‐rural disparities.

Từ khóa


Tài liệu tham khảo

American Cancer Society, 2013, Cancer Facts & Figures 2013

10.1093/jnci/djq495

Centers for Disease Control and Prevention. National Vital Statistics Reports. Deaths: Final Data for 2012. NVSR Volume 63 Number 9. 85 pp. (PHS) 2014‐1120; 2012. Available at:http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_09.pdf. Accessed February 8 2015.

10.1001/archdermatol.2009.389

10.1093/jnci/djn103

10.1377/hlthaff.20.4.188

10.1111/j.1475-6773.2010.01082.x

10.1377/hlthaff.2011.0650

10.1089/jpm.2010.0504

10.1038/pcan.2010.5

10.1001/archinternmed.2008.616

10.1016/j.whi.2008.02.008

10.1089/jwh.2006.0012

10.7326/0003-4819-140-4-200402170-00009

10.1016/j.socscimed.2007.05.028

Bentur N, 2014, Utilization and cost of services in the last 6 months of life of patients with cancer – with and without home hospice care, Med, 31, 723

10.1001/archinternmed.2010.360

10.1089/jpm.2006.9.1292

10.1111/j.1532-5415.2004.52213.x

10.1200/JCO.2003.06.142

10.1093/geront/gnr143

10.1111/j.1748-0361.2006.00022.x

10.1111/jrh.12074

10.1007/s10900-014-9850-x

Centers for Medicare and Medicaid Services.Chronic Condition Data Warehouse. Available from:http://www.ccwdata.org/web/gues/user-documentation. Accessed February 2 2015.

10.1177/1527154404266785

United States Department of Agriculture. Urban Influence Code. Available from:http://www.ers.usda.gov/data-products/urban-influence-codes.aspx. Accessed February 8 2015.

10.1023/A:1011240019516

10.2105/AJPH.82.5.703

10.1023/A:1008811432436

10.1097/01.mlr.0000182534.19832.83

10.1097/01.mlr.0000182534.19832.83

10.2307/1391852

10.1016/S0167-6296(01)00086-8

MedPAC. June 2003Report to the Congress: Variation and Innovation in Medicare. Available at:http://www.medpac.gov/-documents-/reports/page/2/. Accessed August 4 2015.

MedPAC. Payment Basics. October 17 2014. Available at:http://www.medpac.gov/-documents-/payment-basics. Accessed August 4 2015.

10.1200/JCO.2007.15.8253

10.2146/ajhp070259

GoldM.Medicare Advantage in 2008. Issue Brief. Available at:https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7775.pdf. Accessed April 10 2015.

National Hospice and Palliative Care Organization.NHPCO's Facts and Figures on Hospice Care in America. October 2014. Available at:http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care. Accessed August 4 2015.

Thông tin
Thông tin xuất bản

Journal of Rural Health

Tập 32 Số 4

353-362

Thông tin tác giả