Background: The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1–1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1–1.8)) medical bills. Conclusions: We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer.
背景：Medicare优先计划为近半数Medicare参保者提供医疗服务，其中癌症幸存者群体正快速增长。尽管该计划普及率不断提升，但其是否能改善癌症幸存者的医疗可及性、治疗结果及费用可负担性仍不明确。方法：我们基于2019年全国健康访谈调查数据，对年龄≥65岁且有自报癌症病史的Medicare参保者进行横断面研究。采用多变量logistic回归分析评估医疗保险计划类型（Medicare优先计划与传统Medicare）与医疗可及性指标、急症护理利用及费用可负担性之间的关联。结果：我们共识别4451名有癌症病史的参保者，加权后对应2019年2660万癌症幸存者。其中35.8%参加Medicare优先计划，64.2%参加传统Medicare。两类参保者在年龄、性别、种族构成、家庭收入、原发癌部位及共病负担方面特征相似。校正分析显示，传统Medicare与Medicare优先计划参保者在医疗可及性或急症护理利用方面无显著差异。然而，参加Medicare优先计划的癌症幸存者更可能担忧医疗费用（34.3% vs. 29.4%；调整后优势比1.3，95%置信区间1.1–1.5）或实际存在支付困难（13.6% vs. 11.1%；调整后优势比1.4，95%置信区间1.1–1.8）。结论：本研究未发现Medicare优先计划的癌症参保者在医疗可及性、费用可负担性或急症护理利用方面优于传统Medicare参保者。此外，Medicare优先计划参保者比传统Medicare参保者更易面临经济压力并难以支付医疗费用。尽管Medicare优先计划提供优厚福利和吸引性激励措施，但对癌症幸存者而言可能并不比传统Medicare更具成本效益。本研究为国会正在进行的重新评估Medicare优先计划在促进癌症患者权益公平性方面的讨论提供了参考依据。
肿瘤(癌症)患者之家