Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Sample
2.3. Outcome Measures
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Sample Size
3.2. Individual Characteristics
3.3. Outcome Measures
3.4. Healthcare Expenditure
3.5. Health Services Utilization
3.6. Inability/Delay in Obtaining Medical Care
4. Discussion
4.1. Health Care Expenditures
4.2. Health Care Utilization
4.3. Inability/Delay Obtaining Medical Care
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Unweighted Distribution | Absolute Standardized Mean Difference (Unweighted) | Weighted Distribution | Absolute Standardized Mean Difference (Weighted) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HDHP without HSA | HDHP with HSA | LDHP | HDHP without HSA vs. HDHP with HSA | HDHP without HSA vs. LDHP | HDHP with HSA vs. LDHP | HDHP without HSA | HDHP with HSA | LDHP | HDHP without HSA vs. HDHP with HSA | HDHP without HSA vs. LDHP | HDHP with HSA vs. LDHP | |||
(n = 353) | (n = 242) | (n= 1140) | (n = 353) | (n = 242) | (n = 1140) | |||||||||
Variables | % | % | % | p a | St. Diff | St. Diff | St. Diff | % | % | % | p a | St. Diff | St. Diff | St. Diff |
Age | ||||||||||||||
18–39 | 10.20 | 15.29 | 13.86 | 0.254 | 0.146 | 0.105 | 0.041 | 10.46 | 12.95 | 12.85 | 0.830 | 0.072 | 0.069 | 0.003 |
40–49 | 18.98 | 20.25 | 17.54 | 0.034 | 0.038 | 0.072 | 16.02 | 17.95 | 16.85 | 0.051 | 0.022 | 0.029 | ||
50–64 | 70.82 | 64.46 | 68.60 | 0.137 | 0.048 | 0.089 | 73.52 | 69.09 | 70.30 | 0.095 | 0.069 | 0.026 | ||
Gender | ||||||||||||||
Male | 32.01 | 33.88 | 33.86 | <0.001 * | 0.039 | 0.038 | 0.001 | 36.07 | 32.88 | 36.40 | 0.657 | 0.066 | 0.007 | 0.073 |
Female | 67.99 | 66.12 | 66.14 | 0.039 | 0.038 | 0.001 | 63.93 | 67.12 | 63.60 | 0.066 | 0.007 | 0.073 | ||
Race/Ethnicity | ||||||||||||||
Hispanic | 9.35 | 7.44 | 15.44 | <0.001 * | 0.071 | 0.226 | 0.297 | 5.65 | 6.10 | 7.52 | 0.954 | 0.017 | 0.069 | 0.053 |
Non-Hispanic White only | 75.35 | 79.75 | 61.67 | 0.109 | 0.339 | 0.448 | 83.05 | 83.04 | 80.60 | 0.000 | 0.061 | 0.061 | ||
Non-Hispanic Black only | 8.22 | 7.02 | 15.79 | 0.045 | 0.285 | 0.330 | 6.67 | 6.22 | 7.19 | 0.017 | 0.020 | 0.036 | ||
Others | 7.08 | 5.79 | 7.11 | 0.060 | 0.001 | 0.061 | 4.63 | 4.64 | 4.70 | 0.001 | 0.003 | 0.003 | ||
Education Level | ||||||||||||||
Highschool or less than high school | 50.99 | 35.95 | 49.39 | <0.001 * | 0.302 | 0.032 | 0.270 | 46.88 | 42.84 | 45.63 | 0.675 | 0.081 | 0.025 | 0.056 |
Greater than high school | 49.01 | 64.05 | 50.61 | 0.302 | 0.032 | 0.270 | 53.12 | 57.16 | 54.37 | 0.081 | 0.025 | 0.056 | ||
Marital Status | ||||||||||||||
Not married/missing | 26.35 | 35.12 | 34.12 | 0.017 * | 0.190 | 0.168 | 0.022 | 27.63 | 29.79 | 29.2 | 0.864 | 0.047 | 0.034 | 0.013 |
Married | 73.65 | 64.88 | 65.88 | 0.190 | 0.168 | 0.022 | 72.37 | 70.21 | 70.8 | 0.047 | 0.034 | 0.013 | ||
Region | ||||||||||||||
North East | 13.03 | 13.22 | 17.63 | <0.001 * | 0.005 | 0.119 | 0.114 | 15.60 | 15.39 | 16.79 | 0.992 | 0.005 | 0.031 | 0.036 |
Midwest | 25.78 | 30.58 | 19.12 | 0.116 | 0.160 | 0.276 | 24.56 | 23.02 | 22.55 | 0.037 | 0.048 | 0.011 | ||
South | 38.53 | 30.99 | 34.56 | 0.160 | 0.084 | 0.076 | 36.38 | 36.35 | 34.59 | 0.001 | 0.038 | 0.037 | ||
West | 22.66 | 25.21 | 28.68 | 0.058 | 0.136 | 0.079 | 23.46 | 25.24 | 26.07 | 0.040 | 0.059 | 0.019 | ||
Family income as % of federal poverty level | ||||||||||||||
Low income or less or missing (<200%) | 16.43 | 7.44 | 14.39 | 0.007 * | 0.295 | 0.067 | 0.228 | 10.79 | 8.44 | 10.89 | 0.876 | 0.077 | 0.003 | 0.080 |
Middle income (200%–400%) | 28.05 | 25.62 | 29.04 | 0.057 | 0.023 | 0.081 | 24.11 | 24.23 | 23.32 | 0.003 | 0.019 | 0.021 | ||
High income (≥ 400%) | 55.52 | 66.94 | 56.58 | 0.241 | 0.022 | 0.219 | 65.10 | 67.33 | 65.79 | 0.047 | 0.015 | 0.033 | ||
Type of insurance coverage | ||||||||||||||
Other | 19.55 | 7.44 | 5.26 | <0.001 * | 0.506 | 0.596 | 0.091 | 9.15 | 7.37 | 7.57 | 0.699 | 0.074 | 0.066 | 0.008 |
Employer-sponsored | 80.45 | 92.56 | 94.74 | 0.506 | 0.596 | 0.091 | 90.85 | 92.63 | 92.43 | 0.074 | 0.066 | 0.008 | ||
Any public coverage | ||||||||||||||
No | 92.92 | 95.45 | 90.35 | 0.021 * | 0.095 | 0.096 | 0.191 | 93.97 | 95.81 | 92.75 | 0.310 | 0.069 | 0.046 | 0.114 |
Yes | 7.08 | 4.55 | 9.65 | 0.095 | 0.096 | 0.191 | 6.030 | 4.19 | 7.25 | 0.069 | 0.046 | 0.114 | ||
Comorbidities | ||||||||||||||
0 | 19.26 | 18.6 | 18.07 | 0.379 | 0.018 | 0.032 | 0.014 | 16.19 | 18.34 | 16.97 | 0.996 | 0.057 | 0.021 | 0.036 |
1 | 20.96 | 27.27 | 20.61 | 0.155 | 0.009 | 0.164 | 19.71 | 20.34 | 20.31 | 0.015 | 0.015 | 0.001 | ||
2 | 20.68 | 19.01 | 22.37 | 0.039 | 0.040 | 0.079 | 23.47 | 22.97 | 23.63 | 0.012 | 0.004 | 0.015 | ||
>3 | 39.09 | 35.12 | 38.95 | 0.082 | 0.003 | 0.079 | 40.63 | 38.35 | 39.09 | 0.047 | 0.032 | 0.015 | ||
Year | ||||||||||||||
2012 | 17.28 | 14.88 | 21.40 | <0.001 * | 0.062 | 0.107 | 0.169 | 18.19 | 18.61 | 18.21 | 1.000 | 0.011 | 0.001 | 0.010 |
2013 | 15.01 | 10.74 | 17.89 | 0.115 | 0.077 | 0.192 | 15.26 | 15.97 | 16.13 | 0.019 | 0.024 | 0.004 | ||
2014 | 15.58 | 17.36 | 15.96 | 0.048 | 0.010 | 0.037 | 16.20 | 15.27 | 16.79 | 0.025 | 0.016 | 0.041 | ||
2015 | 14.45 | 15.70 | 16.49 | 0.033 | 0.054 | 0.021 | 17.52 | 16.91 | 16.68 | 0.016 | 0.022 | 0.006 | ||
2016 | 18.70 | 19.83 | 16.40 | 0.030 | 0.061 | 0.091 | 18.30 | 18.52 | 17.73 | 0.006 | 0.015 | 0.021 | ||
2017 | 18.98 | 21.49 | 11.84 | 0.073 | 0.207 | 0.279 | 14.54 | 14.72 | 14.45 | 0.005 | 0.003 | 0.008 |
Variable | LDHP as Reference | HDHP with HSA as Reference | |||
---|---|---|---|---|---|
Predicted Mean | 95% CI | p Value | p Value | ||
HEALTHCARE EXPENDITURE ($) | |||||
Total | |||||
HDHP without HSA | $23,255 | ($17,207–$29,302) | 0.016 * | 0.012 * | |
HDHP with HSA | $15,580 | ($12,772–$18,387) | 0.681 | ||
LDHP | $16,261 | ($13,667–$18,854) | |||
Self ($) | |||||
HDHP without HSA | $6089 | ($5322–$6857) | 0.002 * | 0.464 | |
HDHP with HSA | $5743 | ($5135–$6350) | 0.012 * | ||
LDHP | $4853 | ($4460–$5245) | |||
Private Insurer ($) | |||||
HDHP without HSA | $17,128 | ($11,176–$23,080) | 0.137 | 0.010 * | |
HDHP with HSA | $9216 | ($6775–$11,657) | 0.045 * | ||
LDHP | $12,654 | ($9526–$15,782) | |||
HEALTHCARE UTILIZATION | |||||
Number of Prescription Meds | |||||
HDHP without HSA | 19.88 | (16.70–23.06) | 0.166 | 0.526 | |
HDHP with HSA | 18.42 | (15.21–21.64) | 0.552 | ||
LDHP | 17.30 | (15.14–19.46) | |||
Number of Office Based Visits | |||||
HDHP without HSA | 11.24 | (9.58–12.90) | 0.174 | 0.795 | |
HDHP with HSA | 10.92 | (9.19–12.66) | 0.978 | ||
LDHP | 10.03 | (9.08–10.98) | |||
Number of Outpatient Visits | |||||
HDHP without HSA | 1.70 | (1.13–2.28) | 0.227 | 0.225 | |
HDHP with HSA | 1.30 | (0.86–1.74) | 0.884 | ||
LDHP | 1.34 | (1.03–1.64) | |||
Any Inpatient discharges (%) | |||||
HDHP without HSA | 13.07% | (9.01%–17.13%) | 0.336 | 0.564 | |
HDHP with HSA | 11.25% | (6.76%–15.73%) | 0.873 | ||
LDHP | 10.84% | (8.61%–13.06%) | |||
Any Emergency Room visits (%) | |||||
HDHP without HSA | 18.65% | (13.92%–23.39%) | 0.303 | 0.778 | |
HDHP with HSA | 17.62% | (12.11%–23.12%) | 0.567 | ||
LDHP | 15.79% | (12.80%–18.79%) | |||
ACCESS TO CARE | |||||
Unable to Get Care (%) | |||||
HDHP without HSA | 6.40% | (2.97%–9.82%) | 0.185 | 0.412 | |
HDHP with HSA | 4.48% | (1.64%–7.31%) | 0.751 | ||
LDHP | 3.91% | (2.02%–5.81%) | |||
Delay Obtaining Care (%) | |||||
HDHP without HSA | 8.09% | (4.84%–11.34%) | 0.743 | 0.365 | |
HDHP with HSA | 10.93% | (6.04%–15.82%) | 0.425 | ||
LDHP | 8.75% | (6.51%–10.99%) |
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Mahashabde, R.; Li, C. Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access. Healthcare 2021, 9, 1090. https://doi.org/10.3390/healthcare9091090
Mahashabde R, Li C. Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access. Healthcare. 2021; 9(9):1090. https://doi.org/10.3390/healthcare9091090
Chicago/Turabian StyleMahashabde, Ruchira, and Chenghui Li. 2021. "Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access" Healthcare 9, no. 9: 1090. https://doi.org/10.3390/healthcare9091090