The financial costs of cancer care are substantial, both in societal terms and to individuals paying for care. This section describes estimates of national cancer care expenditures and, with the limited data that are available, the distribution of costs by cancer site or phase of care. Chapter 3 discusses financial costs from a patient perspective and reviews potential financial barriers to access to care related to the absence of insurance coverage or to inadequate insurance coverage for care.
In 1998, the "direct" health care cost of delivering cancer care (e.g., hospital and outpatient care, nursing home care, home health care, doctors and other providers, drugs) was estimated to be roughly $50 billion, representing about 5 percent of U.S. health care expenditures (Martin Brown, Head, Health Services and Economics Section, Applied Research Branch, Cancer Surveillance Research Program, National Cancer Institute, personal communication, October 19, 1998; Schuette et al., 1995). Most "direct" cancer care expenditures cover hospital care (65 percent) and physicians' services (24 percent) (Brown and Fintor, 1995). The economic burden of cancer is substantially higher if "indirect'' costs are considered, for example, those associated with lost earnings and reduced work productivity (Brown and Fintor, 1995).
Direct medical costs for cancer exceed those for most other chronic illnesses. In one study of chronic health care direct costs in a large staff-model health maintenance organization (HMO), the annual costs for cancer exceeded by far the annual costs associated with other chronic diseases such as heart disease, diabetes, depression, and multiple sclerosis. A person diagnosed with heart disease accounted for 40 percent more in annual costs than someone without such a diagnosis, after controlling for age, sex, and presence of other chronic conditions. For cancer, there was more than a ninefold increase in annual cost (Fishman et al., 1997). Factors contributing to the high costs associated with cancer care include the specialized facilities and personnel used to deliver therapy, the inherent toxicity and other risks associated with anticancer treatments, the complexity of the disease