Disparities in health expenditure according to the economic status of cancer patients at the end of life

This article was originally published here

BMC Cancer. 2022 Mar 22;22(1):303. doi: 10.1186/s12885-022-09373-y.


BACKGROUND: The desire for better outcomes influences cancer patients’ willingness to pay. While cancer costs are known to have a U-shaped distribution, the actual level of healthcare used by patients may vary depending on income and ability to pay. This study examined the patterns of healthcare expenditure during the last year of life in patients with gastric, colorectal, lung and liver cancer and analyzed whether there are differences in the level of end-of-life costs for cancer care by economic status.

METHODS: This study is a retrospective cohort study that used data from the Korean National Cohort of Elderly Samples, from 2002 to 2015. End of life was defined as 1 year before death. Economic status was classified into three categorical variables according to the level of insurance premium (quantiles). The relationship between the dependent and independent variables was analyzed using multiple gamma regression based on the Generalized Estimated Equation (GEE) model.

RESULTS: This study included 3083 cancer patients, in whom total health care expenditure was highest in the high-income group. End-of-life costs increased the most in the last 3 months of life. Compared to people in the ‘medium’ economic status group, those in the ‘high’ economic status group (RR 1.095, 95% CI 1.044-1.149) were likely to spend more. The percentage of people visiting a general hospital was highest in the “high” economic status group, followed by the “medium” and “low” economic status groups.

CONCLUSION: Health care costs for cancer care increased at end of life in Korea. Patients of higher economic status tended to spend higher amounts of end-of-life costs for cancer care. Further in-depth studies are needed as end-of-life medical costs constitute a significant portion of overall expenditures. This study offers insight by showing that spending on cancer care tends to increase significantly in the last 3 months of life and that differences exist in the amount spent by economic status.

PMID:35317774 | DOI:10.1186/s12885-022-09373-y