and variability in patient response, and the advent of new technologies (e.g., radiotherapeutic equipment, new drugs, diagnostic tests) (Bailes, 1995; Lazar and Desch, 1998).

Cancer is a diverse set of conditions, so it is not surprising that the cost of cancer care varies by the type of cancer. In one analysis within a large staff-model HMO, the costs of initial, continuing, and terminal care were found to vary for three cancers: colon, prostate, and breast. The costs associated with each treatment phase varied by stage at diagnosis, patient age, and the presence or absence of other diseases, and the patterns of variation differed for each type of cancer. The total costs of initial care, for example, increased with stage at diagnosis for colon and breast cancer, but not for prostate cancer (Taplin et al., 1995).

The variation in cost by type of cancer and stage of illness is also seen in a study of Medicare payments. Among the Medicare population, average payments varied among cancer sites, especially in the initial care phase, where payments were highest for lung and colorectal cancers and lowest for female breast cancer (Table 2.5).

Efforts to promote cancer screening among the elderly will likely increase Medicare costs. Persons diagnosed at earlier stages incur higher total Medicare payments between diagnosis and death than those diagnosed at later stages, reflecting their longer survival. Total Medicare payments from diagnosis to death were lowest for those with lung cancer, mainly because of short survival times (Table 2.6).

Impact of an Changing Health Care System On Cancer Care

Cancer is a common chronic illness whose management is costly, technology dependent, and interdisciplinary and extends from prevention to end-of-life care. It thus illustrates the challenges posed by the increasingly complex and dynamic American health care system. This section describes how one dominant force of change, the rise in managed health care, has affected essential aspects of health care delivery that are important to individuals with cancer. Another trend, the tendency for employers to assume financial risk and to self-fund or insure their own health plans, is also described because it has limited the applicability of cancer-related, state-mandated health benefits and consumer protections.

TABLE 2.5

Average Medicare Payments by Site and Phase of Cancer (1990 dollars per person-year)

 

Lung

Female Breast

Prostate

Colon or Rectum

Bladder

Less than 1 year survival

$19,199

$16,475

$18,698

$22,473

$21,529

Survived I year or more

Initial

17,518

8,913

10,235

17,505

10,717

Continuing care

4,305

3,138

3,788

3,625

4,656

Pre-final

9,985

7,633

8,542

9,056

10,036

Final

13,217

11,129

12,061

12,028

13,633

 

SOURCE: Riley et al., 1995.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement