2026. Estimating Out-of-pocket Expenditures for Privately Insured Cancer Patients
J Lee, VA Chicago Healthcare System-Lakeside Division, CL Bennett, VA Chicago Healthcare System-Lakeside Division

Objectives: The National Institutes of Health (NIH) estimates that the overall costs for cancer in 2001 were $156.7 billion.  However, this estimate does not include out-of-pocket costs (OPC), which may account for large expenditures encountered by patients and caregivers.  The objective of this study is to provide preliminary estimates of the type and magnitude of OPCs experienced by cancer patients and their caregivers.

Methods: A comprehensive, multi-dimensional survey instrument was utilized to provide a three-month retrospective assessment of patientsí total healthcare costs.  Patients with breast (n=142), colorectal (n=47), lung (n=20), and prostate cancer (n=10) were surveyed regarding OPCs before and after diagnosis.  For each cost item, the prevalence of patients reporting increases in monthly OPC and the mean monthly OPC were calculated.

Results:  Patients varied with respect to types of insurance: private fee-for-service insurance (65.8%), Medicare (19.2%), HMO (8.2%), and other (VA, Medicaid, and uninsured) types of insurance (6.8%). The most common sources of monthly OPC were transportation (77.6%), medications (68.0%), physician visits (51.1%), restaurant bills (47.0%), and hospital bills (40.6%).  However, the mean costs of these expenditures varied: transportation ($37), hospital ($195), physician visits ($65), and medications ($59).  Over 95% of patients had an increase in OPC since cancer diagnosis, with a mean monthly increase of $551.  Mean monthly OPCs varied by type of insurance: $659 for fee-for-service private insurance, $382 for Medicare, $246 for HMO, and $360 for other types of insurance.

Conclusions: OPCs for privately insured cancer patients contribute substantially to the total financial burden placed on cancer patients and their caregivers.  Future economic studies should include out-of-pocket costs in order to gain a more comprehensive assessment of the total cost of cancer care.

Impact: While private health insurance pays for a major portion of the cost of cancer treatment and care, patients and their caregivers still face considerable OPCs. In the absence of comprehensive long-term care and pharmaceutical benefit programs, safety net programs such as the VA are very important to many of these individuals.