Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Population
2.2. Outcomes
2.3. Statistical Analysis
3. Results
3.1. Healthcare Access
3.2. Acute Care Utilization
3.3. Healthcare Affordability
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Beneficiaries, Weighted % | p Value | |
---|---|---|---|
Traditional Medicare (n = 17,098,164) a | Medicare Advantage (n = 9,521,181) a | ||
Age, mean (SD), y | 76.2 (49.7) | 75.8 (47.7) | 0.85 |
Sex | |||
Male | 46.0 | 43.3 | 0.12 |
Female | 54.0 | 56.7 | |
Race and ethnicity | |||
White | 82.5 | 79.1 | 0.21 |
Black | 8.1 | 9.6 | |
Asian | 2.0 | 2.5 | |
other | 1.7 | 2.7 | |
Hispanic | 5.6 | 6.2 | |
Income, (% of the FPL) | |||
<100 | 8.3 | 7.5 | 0.68 |
100–199 | 21.3 | 21.8 | |
200–399 | 32.7 | 34.6 | |
≥400 | 37.4 | 35.9 | |
Unknown | 0.3 | 0.2 | |
Metropolitan status | |||
Non-urban | 22.0 | 13.8 | <0.01 |
Urban | 78.0 | 86.2 | |
Region | |||
Northeast | 20.4 | 15.9 | <0.01 |
Midwest | 22.0 | 21.8 | |
South | 39.7 | 38.4 | |
West | 17.9 | 23.9 | |
Primary site b | |||
Breast | 23.2 | 25.6 | 0.2 |
Gastrointestinal | 8.4 | 8.1 | |
Gynecologic c | 10.4 | 10.9 | |
Head & Neck | 5.1 | 5.4 | |
Hepatopancreatobiliary | 1.6 | 1.2 | |
Leukemia or lymphoma | 4.5 | 6.2 | |
Lung or bronchus | 4.3 | 4.6 | |
Melanoma | 5.9 | 6.3 | |
Other | 11.0 | 8.5 | |
Urologic d | 25.5 | 23.2 | |
Co-morbidities | |||
Diabetes | 22.6 | 22.3 | 0.84 |
Hyperlipidemia | 56.3 | 54.3 | 0.25 |
Hypertension | 65.3 | 65.1 | 0.93 |
Coronary heart disease | 17.5 | 17.5 | 0.99 |
Stroke | 9.6 | 9.5 | 0.97 |
COPD | 13.6 | 14.5 | 0.42 |
Asthma | 13.1 | 14.4 | 0.31 |
Dementia | 4.5 | 3.8 | 0.42 |
Depression | 18.0 | 20.2 | 0.15 |
Outcome | Beneficiaries, % a | Unadjusted Odds Ratio (95% CI) | p Value | Adjusted Odds Ratio (95% CI) b | p Value | |
---|---|---|---|---|---|---|
Medicare Advantage | Traditional Medicare | |||||
Has a usual source of care | 95.5 | 94.8 | 1.2 (0.8–1.7) | 0.35 | 1.2 (0.8–1.8) | 0.29 |
Had a doctor visit in the last year | 98.2 | 97.7 | 1.3 (0.8–2) | 0.35 | 1.3 (0.8–2.2) | 0.33 |
Met aerobic physical activity recommendations | 31.8 | 32.3 | 1.0 (0.7–1.3) | 0.89 | 1.0 (0.7–1.3) | 0.78 |
Had blood pressure evaluated in the last year | 99.3 | 98.6 | 2.1 (0.7–6.6) | 0.21 | 1.9 (0.6–6.2) | 0.27 |
Had blood glucose evaluated in the last year | 90.7 | 91.2 | 0.9 (0.7–1.3) | 0.74 | 1.0 (0.7–1.5) | 0.87 |
Had cholesterol evaluated in the last year | 93 | 94.4 | 0.8 (0.5–1.2) | 0.29 | 0.8 (0.5–1.3) | 0.31 |
Outcome | Beneficiaries, % a | Unadjusted Odds Ratio (95% CI) | p Value | Adjusted Odds Ratio (95% CI) b | p Value | |
---|---|---|---|---|---|---|
Medicare Advantage | Traditional Medicare | |||||
Visited an urgent care clinic ≥ 2x in the last year | 9.9 | 11.1 | 0.9 (0.7–1.1) | 0.31 | 0.9 (0.7–1.2) | 0.37 |
Visited an emergency department in the last year | 28.3 | 29.6 | 0.9 (0.8–1.1) | 0.47 | 0.9 (0.8–1.1) | 0.41 |
Had an overnight hospitalization in the last year | 20.4 | 20.5 | 1.0 (0.8–1.2) | 0.92 | 1.0 (0.8–1.2) | 0.96 |
Outcome | Beneficiaries, % a | Unadjusted Odds Ratio (95% CI) | p Value | Adjusted Odds Ratio (95% CI) b | p Value | |
---|---|---|---|---|---|---|
Medicare Advantage | Traditional Medicare | |||||
Worried about paying medical bills in last year | 34.3 | 29.4 | 1.3 (1.1–1.5) | 0.01 | 1.3 (1.1–1.5) | 0.01 |
Had problems paying or inability to pay medical bills in last year | 13.6 | 11.1 | 1.3 (1–1.6) | 0.06 | 1.4 (1.1–1.8) | 0.02 |
Delayed medical care to save money in the last year | 4.3 | 3.9 | 1.1 (0.7–1.7) | 0.62 | 1.3 (0.8–1.9) | 0.32 |
Delayed filling medications to save money in the last year | 5.5 | 5.0 | 1.1 (0.8–1.6) | 0.51 | 1.1 (0.8–1.5) | 0.66 |
Skipped prescription medications to save money in last year | 4.3 | 3.2 | 1.4 (0.9–2) | 0.12 | 1.5 (1–2.3) | 0.06 |
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Jafri, F.I.; Patel, V.R.; Xu, J.; Polsky, D.; Gupta, A.; Hussaini, S.M.Q. Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors. Cancers 2023, 15, 3964. https://doi.org/10.3390/cancers15153964
Jafri FI, Patel VR, Xu J, Polsky D, Gupta A, Hussaini SMQ. Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors. Cancers. 2023; 15(15):3964. https://doi.org/10.3390/cancers15153964
Chicago/Turabian StyleJafri, Faraz I., Vishal R. Patel, Jianhui Xu, Daniel Polsky, Arjun Gupta, and Syed Mohammed Qasim Hussaini. 2023. "Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors" Cancers 15, no. 15: 3964. https://doi.org/10.3390/cancers15153964