OBJECTIVES : This study examined the association between health insurance coverage and healthcare expenditures and healthcare use among cancer survivors living in the United States.

METHODS : A retrospective, cross-sectional study was conducted using the most recently available Medical Expenditure Panel Survey (MEPS) data from 2017. The study sample comprised of adults aged ≥ 18 years identified using International Classification of Diseases, Tenth Revision, (ICD-10) codes specific for cancer. Insurance coverage was categorized as private, public, and uninsured. Total direct healthcare expenditures and healthcare use (prescription medications, inpatient, outpatient, physician and emergency visits) were determined. Multivariable ordinary least square (OLS) regression on logarithmically transformed expenditures were conducted and the estimates were retransformed using Duan’s smearing estimators.

RESULTS : Using 2017 MEPS data, 1177 cancer survivors with a weighted estimation of 14,092,689 were identified among which 64.4% had private insurance, 34.1% had public insurance, and 1.5% were uninsured. The adjusted mean total expenditures were higher for individuals with public insurance ($15,146; p<0.05) and private insurance ($13,981; p=0.053) when compared to those without any insurance ($5,817; p<0.0001). Unadjusted analysis showed that compared to those with private and public insurance, uninsured cancer survivors had fewer physician office visits ( 97.6% and 95% vs 70.1%; p<0.001), prescription medication use (90.3% and 96% vs. 61.2%;p<0.001), outpatient visits (38.6% and 39.7% vs. 18.1%;p=0.151) and inpatient admission. (13.3% and 18.3% vs. 15.4%, p=0.0124). However, emergency room visits were higher for those who were uninsured compared to those who had public or private insurance coverage (33% vs 16.4% and 26%;p<0.001).

CONCLUSIONS : Significant differences in expenditures were found between those with public insurance and those who were uninsured. One possible explanation for these differences is lower use of health care services among uninsured. Expansion of insurance coverage to the uninsured population can help them to receive adequate cancer care.