Statistics: Who Visits the Emergency Room? 20 Percent of Americans, Insured or Not

Here are some interesting facts about who visits the ER from The New York Times. One interesting fact to take note of, people with private insurance visit the ER almost as much as people without insurance.

By RONI CARYN RABIN

Americans, insured and not, make ample use of hospital emergency rooms: One out of every five visited an E.R. at least once in 2007, the latest year for which the National Center for Health Statistics has data.

Among the uninsured, 7.4 percent made two or more visits to an E.R., but so did 5.1 percent of people with private insurance. Medicaid recipients were the heaviest users of E.R.’s, with 15.3 percent of them making two or more visits during the year.

Adults in fair or poor health were most likely to go to an E.R. More than a third of them visited an emergency room at least once during the year.

People younger than 65 who said the E.R. was their only health care facility were no more likely to have gone to an emergency room than others, and for those older than 65, there were more E.R. visits by people with a usual source of care than by those without one.

More than 25 percent of non-Hispanic blacks visited an E.R., compared with 20 percent of whites and about 18 percent of Hispanics. For people younger than 75, age made little difference.

In all age groups, about one in five people went to the E.R. But among those older than 75, one in four visited the E.R. at least once.

The uninsured were no more likely to make non-emergency visits to the E.R. than anyone else — about 10 percent of visits were for non-emergencies, whether the patients had private insurance, Medicaid coverage or no insurance.

Figuring out who visits emergency rooms, how often and for what reasons involves sorting out complex interactions among many factors — socioeconomic level, health status, age, health insurance, access to health care and others.

“Our job is to provide the best numbers to inform policy and practice,” said Amy B. Bernstein of the National Center for Health Statistics. “If people are concerned about the use of emergency rooms and how to make their use more efficient or effective, they should have accurate information about who is actually using them — and not who they think is using them.”

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Workshop warns business to brace for surging health care costs

Will the new healthcare reform act be beneficial to patients at the cost of being harmful to business? The jury is still out, but onething is for certain, costs will continue to rise in the immediate future.

The Daily – 07/22/10

By Beth Fitzgerald

As the new federal healthcare reform law is phased in through 2014, employers will face increased costs to comply with new regulations and reporting requirements, even as their health insurance premiums continue to rise.

That was the view from Scott Rappoport, CEO of Benefit Sources & Solutions, in

Bound Brook, who presented a workshop on the new law Thursday morning sponsored by the Somerset County Business Partnership. The session was held at Financial Resources Federal Credit Union’s Bridgewater office.

Rappoport reviewed key provisions of the law, starting with the “grandfathering” of healthplans that were in effect when the new law was adopted by Congress on March 23.  Many employers can keep their old plans – but the restrictions are such that, in most cases, it will be too costly to try and hang on to an old plan, he said. “I really believe that in two years, it will be so ridiculously expensive to maintain a grandfathered plan that it won’t make any sense,” he said.

One positive aspect of the law is that it spells out the “essential benefits” – including preventive care – health plans must provide, he said, which addresses a need to “focus on wellness and chronic disease management, and getting and staying well.”

In 2010,employers with fewer than 25 workers averaging salaries of $50,000 or less who pay 50 percent of their health insurance premiums can get a tax credit of 35 percent of the employer’s premium contributions. But Rappoport said in New Jersey, a high-wage state, many small employers won’t qualify.

Yet New Jersey Citizen Action, a consumer advocacy group, this week released a report by Washington, D.C. – based Families USA that estimated more than 100,000 New Jersey businesses could be eligible for the tax credit this year.

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Hijacked, Stolen Health Care Reform: Why Health Care Costs Will Not Be Contained

Costs continue to rise even with the passage of landmark healthcare reform. Read the following article for an interesting take on outcomes of the new reform.

John Greyman

The passage of the Patient Protection and Affordable Act of 2010 (PPACA), our new health care legislation, in March was hailed by its supporters as an historic event of the magnitude of Social Security and Medicare. But four months later, it remains controversial, with repeated polls showing three large groups of divisive opinion, including those who would work to repeal it and others who believe that it will make no difference. The Democrats have launched a $125 million PR campaign to defend the new law amidst growing signs that many Democrats facing re-election are failing to get political traction on the issue. (1)

We are being advised by many to “wait and see” how this complex new bill plays out over the next five to ten years, but we can already know what its outcomes will be. More than 30 years of health policy science, including documentation of the repeated failures of incremental changes built into the new law, together with well-entrenched trends in our market-based system, allow us to project its outcomes with confidence. For this legislation has been molded and crafted by the political power and money of corporate stakeholders in the medical-industrial complex.

Five previous posts in 2009 described the uneasy “alliance” of the five biggest players — the insurance industry, the drug industry, the hospital industry, business and organized medicine. They will do just fine with the new law at the expense of patients, families and Main Street.

Health care “reform” this time around was intended to address these four basic system problems: (1) containing health care costs, (2) making health care more affordable, (3) increasing access to care, and (4) improving the quality of care. This post introduces a series of five that will examine how well the PPACA will do on each of these four goals, followed by an overall assessment of the law. These posts will draw in part from my new book Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform, soon to be released by Common Courage Press in both print and eBook format.

Continued Unrestrained Drivers of Health Care Costs

These are some of the many reasons that we can already conclude that health care costs will continue to run out of control at rates far exceeding the costs of living and median household incomes.

• No price controls. Wall Street has already factored in rapid expansion of markets for drugs, medical devices and other services in a system of expanded access. There is also a long line forming of providers of information technology and administrative services that will exploit the complex implementation of this law.

• No bulk purchasing. The PPACA has prohibited the government from negotiating the prices of prescription drugs and retains a ban on importation of drugs from Canada and other countries.

• Lack of control over perverse incentives that drive increased volume of services. These in turn are driven by retention of fee-for-service (FFS) reimbursement that encourages physicians and other providers to offer more services than are medically appropriate or necessary.

• No effective mechanism to rein in marginal or ineffective technologies. Coverage policies for new drugs and medical devices are still lax and not subject to rigorous evidence-based criteria for either efficacy or cost-effectiveness.

Although the PPACA does call for a Patient-Centered Outcomes Research Institute, its role is already neutered by not having the power to mandate or even endorse coverage or reimbursement rules for any particular treatment. (2)

• The dominant business model of health care prevails, with many facilities and services remaining for-profit and investor-owned and with an ongoing trend for increasing consolidation within industries.

• The PPACA has grandfathered-in specialty hospitals, typically physician-owned facilities that focus on well-reimbursed procedures in such areas as cardiology and orthopedics, whereby physicians can “triple dip,” earning high incomes as providers, owners and investors.

• More preventive services will further fuel health care inflation. While the PPACA does provide new coverage for many preventive services, this will lead to increased costs due to additional diagnostic and treatment services engendered. (3)

• Private insurers can’t contain health care costs, even where they have dominant market power. A 2009 report by the Congressional Research Service, “The Market Structure of the Health Insurance Industry,” concludes that:

The exercise of market power by firms in concentrated markets generally leads to higher prices and reduced output — high premiums and limited access to health insurance — combined with high profits. (4)

• There are no controls over premium rate increases by insurers. Despite the outcry by government officials, annual premium rates are escalating at rates up to 56 percent (5), and there is no end in sight for continued exorbitant rate increases. Insurers will continue to game the system by extracting maximal profits and offering reduced coverage with actuarial values (the amounts insurers actually pay in coverage) as low as 60 or 70 percent.

• National health care spending will grow unabated despite the passage of
PPACA. The Centers for Medicare and Medicaid Services (CMS) projects that overall national health expenditures (NHE) will increase from its present 17 percent of GDP to 21 percent in 2019, a total of $4.470 billion. (6)

These well-documented trends leave no room to think that health care “reform” will have any chance to contain health care costs. Instead, health care inflation will be exacerbated by all the new incentives and inefficiencies in the new “system.” In our next post we will examine the impact of these trends on affordability of health care.

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When Choosing Health Care, Know What You’ll Owe

Buyer beware! Most people don’t realize just how much out-of-pocket spending a healthplan may cost them until they become seriously ill or are hospitalized. The below article sheds light on the out-of-pocket expenses many consumers face and what they should be aware of when choosing a healthplan.

By WALECIA KONRAD

If you’re like most people, you may think they are the same. But while it is true both terms refer to the portion of medical bills you pay out-of-pocket, these two types of cost-sharing are quite different.

A co-pay is a fixed amount that you pay each time you see a doctor or fill a prescription, usually around $10 or $20. Co-insurance is the percentage of the cost of doctor visits, hospitalizations and prescription drugs that you must pay under your insurance policy.

Let’s say your policy calls for 80/20 co-insurance. After you meet your deductible, you must pay 20 percent of your medical bills; the insurance company is responsible for the remaining 80 percent.

Many plans demand both co-pays and co-insurance. Co-insurance is especially common when it comes to hospital stays. Of all workers covered by an employer-sponsored group health plan, 51 percent must pay co-insurance for hospital admissions, according to the 2009 Kaiser Family Foundation survey of employer health benefits. The average payment is 18 percent of the total. And 53 percent of covered workers pay co-insurance for outpatient hospital visits, with an average charge of 19 percent.

Co-insurance is common in the individual insurance market. And as companies head into this fall’s open enrollment season, many are considering a switch from co-pay to co-insurance as a way to increase employee cost-sharing and contain rising health benefit expenses, said Tom Billet, director for health and group benefits at the consulting firm Towers Watson.

Because of the confusion involving co-pay and co-insurance, many patients don’t realize just how much it may cost them until they become seriously ill or are hospitalized, said Lynn Quincy, a senior policy analyst at Consumers Union. “Ten or 20 percent may not sound like much, but 20 percent of a $100,000 surgery is a lot of money,” she said.

Co-insurance payments can add up quickly for seriously ill patients. It’s not unusual, for example, for a cancer patient to need $40,000 worth of medicine in a given year.

“Co-insurance on that could be as much as $14,000, and that’s just for the drugs. That’s not even counting going to the doctor or the hospital yet,” said Stephen Finan, senior director of policy at the American Cancer Society’s Cancer Action Network.

High co-insurance and other out-of-pocket costs, including insurance premiums, can sometimes discourage patients from receiving the treatment they need. One in three individuals under age 65 diagnosed with cancer has delayed needed health care in the last 12 months, according to a Cancer Action Network poll.

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Employers’ Medical Costs to Rise in 2011

Looks like medical costs are expected to trend well above inflation for 2011. In addition, consumer out-of-pocket costs have increased as employers continue to shift the cost onto employees.

Medical costs are expected to increase by 9 percent in 2011, according to a report from PricewaterhouseCoopers LLP. Although the increase is down 0.05 percent from the 2010 growth rate, it still is expected to outpace the rate of inflation. For the first time, the majority of the American workforce is expected to have a health insurance deductible of at least $400 as more employers return to indemnity-style cost sharing by raising out-of-pocket limits, replacing co-payments with co-insurance and adding high-deductible health plans.

Hospital and physician costs, which make up 81 percent of premium costs, are the biggest inflators of the 2011 medical cost trend. Hospitals shifting costs from Medicare to private payers and employers is seen as the top reason for higher medical cost trends. In 2011, Medicare will reduce payment rates to hospitals for the first time after seven years of increases that almost matched or exceeded inflation increases. Some hospitals that benefitted from higher payments in 2008 and 2009 may be able to manage this type of cut by tapping their reserves, but many hospitals are likely to shift more costs to commercial payers during their negotiations, according to the report.

In addition, increasing consolidation among physician practices is expected to increase their bargaining power. Payers expect to see more negotiating power and higher prices in the short term, but efficiencies created by consolidation will moderate future rate hikes.

The report findings are based on a survey of more than 700 employers from 30 industries and interviews with health plan actuaries.

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Doctors tack on ‘a la carte’ fees for patients

It appears that physicians are now charging ‘a la carte’ fees for services not traditionally covered by insurance or Medicare. The extra fees mean greater out-of-pocket costs for consumers. Read on to learn more.

By Alison Young • USA TODAY •

A growing number of doctors across the country are boosting revenue by asking patients to pay new fees for services they say insurance doesn’t cover, insurance and physicians’ groups say.

The extra payments include no-show fees of $30-$50 for missed appointments, widely varying charges for filling out health forms for school, work or athletic teams, and annual administrative fees of $35-$120 or more to simply be a patient in some practices, medical associations and doctors say.

“It’s not unlike the airlines,” said William Jessee, president of the Medical Group Management Association, which generally advises against extra fees that may anger patients or run afoul of insurance contracts. “They’ve gone from all-inclusive to a la carte. That’s what you’re seeing with physicians.”

Doctors who charge extra fees are in the minority, he said. Some have done it for years, but more are joining them because they say they need the fees to offset the rising costs of practicing medicine.

Allen Greenlee, an internist in Washington, sent a letter in March to 7,000 patients in his group practice asking for a voluntary $35 annual administrative fee for costs insurance didn’t cover. He said he got only two angry letters and dozens paid extra to help others. “I’m trying to stay solvent,” he said.

WellPoint, the nation’s largest insurer by membership, is receiving more inquiries from doctors seeking to charge annual administrative fees.

“We have seen some increase in that type of activity,” said John Syer, a vice president over provider contracting at WellPoint, which operates 14 Blue Cross and Blue Shield plans. “The vast majority do not engage in that,” Syer said, noting such fees may violate provider agreements if doctors charge for items insurers consider included in their payments.

Though no national data are available on how many practices charge extra fees, Jessee said primary care doctors face increased financial pressures as insurance reimbursement hasn’t kept pace with costs. The result has been a growing shortage of primary care physicians as medical students choose more lucrative specialty fields. Primary care is critical to the nation’s new health law, which will give 32 million uninsured Americans coverage.

Office visits are the main source of insurance payments to primary care doctors, yet physicians spend much of each day on activities they’re not directly compensated for, such as phone calls and prescription refills, a study in The New England Journal of Medicine in April found.

“A lot of doctors are trying all kinds of experimental things just to survive,” said Gary Seto, a doctor in South Pasadena, Calif., who charges an annual $120-per-family “non-covered benefits fee.”

Sue Braga of the Arizona chapter of the American Academy of Pediatrics said she’s hearing of more practices charging for no-shows and health forms.

Susan Wheeler, 33, said her kids’ pediatrician near Atlanta recently started a $10-per-child form fee. “I don’t like it,” she said. “It’s part of their job.”

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Medical Costs Rise 7.8 Percent in 2010 for Family of Four: Milliman

Healthcare Financial News

Medical costs are on the rise again in 2010. Read the article and then go to the report from Milliman that details the rise in costs for the third straight year in a row.

The medical costs paid by and on behalf of a typical U.S. family of four reached $18,074 in 2010, up 7.8 percent over the 2009 amount of $16,771, according to the 2010 Milliman Medical Index. For the third consecutive year, the annual rate of increase has been less than 8 percent, but the dollar increase is the highest in the past 10 years. Inpatient and outpatient facility services combined represent 48 percent of the total annual medical costs, up from 47 percent last year, according to the index. Physician services represent 33 percent, prescription drugs represent 15 percent, and miscellaneous services represent 4 percent.

Over the past five years, pharmacy care and facility costs, especially outpatient facility costs, increased at a higher average annual rate than physician services, the report states. The largest dollar increase in 2010 was for inpatient facility care, which rose by $498 annually. The increase includes change in both utilization and average unit cost. Average unit cost reflects the negotiated charge for each service and the service mix, according to Milliman.

Most of the hospital and physician cost increases noted in the 2010 index have been driven by average unit cost, not utilization, which frames the future cost-control effort, according to the report. Hospital and physician services contributed $820 and $301, respectively, to the increase in total annual medical costs between 2009 and 2010, while pharmacy services contributed $151.

As in 2009, medical costs in three cities (Miami, New York, and Chicago) continue to surpass the national average by at least 10 percent. Costs in all three cities now exceed $20,000 for a typical family of four, with Miami at $22,089. Phoenix and Seattle continue to have costs much lower than the national average.

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Study says companies expect health reform to raise costs

Many employers are worried that the new healthcare reform will raise the cost of care and that the increased cost will be passed on to employees. Read more.

THE ASSOCIATED PRESS • May 25, 2010

Big companies think health care reform will hike their costs, but most expect to continue offering subsidized benefits to workers, according to a new Towers Watson study.

The benefits consultant surveyed 661 companies this month and found that 94 percent of those that responded believe the reform law passed by Congress earlier this year will raise costs. Eighty-eight percent plan to pass the increases on to employees, and 74 percent anticipate reducing health benefits and programs.

That could mean insurance co-payment or deductible hikes or more high-deductible plans, said Mark Maselli, who heads Towers Watson’s North American Health and Group Benefits unit.

He added that companies will likely continue to offer “medical coverage that individuals are used to having” at least for the foreseeable future. Nearly three quarters of the companies responding to the survey said they expect to continue providing subsidized coverage for active employees.

Maselli said benefits could change as the reform law unfolds over the next few years. But he saw no need for employees to panic.

“You’ve got coverage now, you’re likely to continue to have it through your employer, and it’s something you want to monitor over time,” he said.

Some companies could see small reform-related cost hikes next year, after the start of provisions that ban lifetime maximums for benefits and extend coverage of young adult dependents on parental plans to age 26. Maselli and other benefits experts say the size of this hike will depend greatly on the company and the employees it covers.

Towers Watson’s national survey spanned several industries and involved companies with a median size of 5,600 employees.

It also found that big companies generally plan to continue offering health promotion and wellness programs. But 43 percent of employers that offer retiree benefits expect to reduce or eliminate them.

Containing health care costs was an essential or high priority for 96 percent of survey respondents, who were asked how important specific reform goals were to their organization.

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Increase in health tests, procedures is raising costs in frugal Utah

The rising cost of healthcare is everywhere. Even in small town communities, where spending tends to be small or limited, people can’t avoid the increase in healthcare costs.  What’s driving the increase? It appears to be over utilization. Essentially, this means that the number of test and procedures is on the rise. This is due to the addition of new surgical and other specialty suites and increased technology at hospitals. These services are all paid for on a fee-for-service type arrangement – meaning the more test one does, the more the doctor or the facility performing the test or service will receive in payment.

By Jordan Rau

Kaiser Health News

PROVO, UTAH — If there is any place that should have medical spending under control, this is it. Residents of Provo, many of them Mormons who don’t smoke or drink, are among the healthiest in the country. The city’s biggest hospital is run by Intermountain Healthcare, which President Obama has lauded for providing high-quality care while restraining costs.

Until recently, Provo seemed to be a model for the nation. But spending on Medicare patients here has accelerated rapidly, as it has in many other areas of the country that are known for cost-efficient care.

The culprit: a swift increase in the number of procedures and tests being performed — a trend that has coincided with the additions of new surgical and cancer treatment suites and diagnostic machines at hospitals and clinics throughout the growing region.

“It’s very discouraging to see costs increasing rapidly in those low-cost areas we believe to have good care,” said Paul B. Ginsburg, president of the Center for Studying Health System Change, a Washington-based research group. “They appear to be succumbing to the same forces that have led to high costs elsewhere.”

This transformation calls into question initiatives — including some in the new health-care law — to encourage more profligate regions to learn from their frugal counterparts.

Medicare spending trends often parallel those in the country’s overall health system, experts say. In 2007, average Medicare spending per person in the greater Provo hospital market was $8,064. That was below the national average of $8,682, but far higher than it had been a few years earlier.

Between 2000 and 2007, Medicare spending in the Provo region rose on average 8.6 percent a year, nearly double the average national rate of 4.7 percent, according to the Dartmouth Atlas of Health Care, which analyzes geographic variations in medical spending. Provo’s growth occurred as Medicare beneficiaries underwent surgeries more frequently and spent more of their dying days in intensive care units.

Provo’s spending increases aren’t an aberration. Annual average spending grew 7 percent or more in other traditionally low-cost areas, including Oxford, Miss.; Wausau, Wis.; and Durham, N.C. Even in Rochester, Minn., home of the highly regarded Mayo Clinic, and Salt Lake City, where Intermountain is headquartered, Medicare costs grew faster than the national average, according to Dartmouth.

The increases are particularly worrisome in places where many providers have made changes to try to reduce costs. These include adopting electronic medical records, focusing on prevention and increasing cooperation between doctors and hospitals.

But Provo’s regional hospital market, which stretches south of Salt Lake City and includes nearly 27,000 Medicare beneficiaries in a population of more than half a million, also has embraced some of the less admired traits of expensive health-care markets.

Many doctors have set up their own large clinics where they share in the profits from diagnostic tests and other services. Physicians in the Provo region performed 17.3 percent more procedures on Medicare patients in 2008 than they did in 2000, outpacing the median national increase of 13.7 percent, according to a Government Accountability Office study.

“The first surgical center in Utah County was built by a physician from the hospital,” said Rulon Barlow, a former county health commissioner who runs the student health center at Brigham Young University in Provo. “So what did the hospital do? It built a surgery center. It wasn’t too much longer that another outfit came in across the street.”

Wendell Gibby, a radiologist who owns an imaging clinic, said he has seen a dramatic change in the area. “The gastroenterologists owning their own CT scanners, the oncologists owning their own radiation machines” are examples, he said. “If you’ve got a $1 million scanner, you end up using it.”

Hospital executives and doctors insist that they guard carefully against performing unneeded procedures. Scott E. Bingham, a cardiologist at the Central Utah Clinic, said: “The only thing that I see increasing in Provo is the number of patients we see.”

And Mike Kennedy, a family doctor and the chief of staff at the Hospital Corporation of America’s Timpanogos Regional Hospital in Orem, just north of Provo, speculates that the higher costs are the result of better care. “You’re probably seeing more aggressive treatment earlier on in disease stages,” he said.

But some treatments were being performed more frequently in Provo while decreasing nationally, according to Dartmouth data covering 2000 through 2005. They included operations to clear leg arteries and replace heart valves.

The number of aortic-aneurism repairs and hospitalizations for hypertension and asthma also rose faster than the national average. Though many procedures are still performed less frequently than elsewhere, a Dartmouth study released in April singled out Provo for having the highest rate of shoulder-replacement surgery in the country.

Commercial insurers say prices in Provo and the rest of Utah still remain lower than the national average. But experts say that could change, too.

“We take some comfort that we have less of a problem in Utah than elsewhere,” said Kim Bateman, vice president for medical affairs at HealthInsight, a Salt Lake City-based nonprofit organization that Medicare has authorized to find ways to improve the quality of care in Utah and Nevada. “But really I think we’re just behind them on the same curve — that we’re going to be subject to the same kinds of cost pressures as everyone else.”

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Study says US cancer costs almost double in 20 years – but not because of pricey treatments

Here’s some news that’s probably not too surprising: Cancer costs have doubled over the past twenty years. As with any serious disease, usually the drugs and the various treatment associated with fighting the disease are expensive; however in this study researchers conclude that rising cost were the direct result of the increased number of cancer patients.

ATLANTA (AP) —

The cost of treating cancer in the United States nearly doubled over the past two decades, but expensive cancer drugs may not be the main reason why, according to a surprising new study.

The study confounds conventional wisdom in several respects. The soaring price of new cancer treatments has received widespread attention, but the researchers conclude that rising costs were mainly driven by the growing number of cancer patients.

The study also finds cancer accounts for only 5 percent of total U.S. medical costs, and that has not changed in the last few decades.

“I will say I’m a bit surprised,” said Dr. Len Lichtenfeld of the American Cancer Society, who said he would have expected the proportion of cancer costs to rise.


The researchers also found that private insurers now cover a greater share of cancer treatment costs — about 50 percent — while patients’ out-of-pocket costs have fallen over the past two decades.

Though taken aback by some of the findings, Lichtenfeld and other experts did not dispute the study, which compared medical cost data from the late 1980s to that of the early 2000s. But they said the picture surely has changed in the last several years.

The study is being called the first to combine national cancer costs for all types of payers and see how they’ve changed over time. The figures are reported in 2007 dollars.

It found that cancer treatment costs rose from nearly $25 billion in 1987 to more than $48 billion by the end of 2005.

The rise in costs is mainly due to an increase over 20 years in how many cancer patients there are, said the study’s lead author, Florence Tangka of the U.S. Centers for Disease Control and Prevention.

The researchers used data from national telephone surveys done in 1987 and from 2001 through 2005, which gathered information on medical conditions as well as who paid the bills. More than 164,000 people were surveyed.

The study did not offer precise estimates of how the number of people treated for cancer changed from the late 1980s to the early 2000s. But it showed dramatic increases in the number of cancer cases covered by the government’s Medicare and Medicaid programs. Medicare, which covers the elderly and disabled, has consistently covered about a third of the nation’s cancer costs. Medicaid accounts for only 3 percent.

The U.S. population is aging, and older people tend to get cancer at higher rates, Tangka noted.

Better and more advanced treatments mean more people with cancer are remaining alive, so the spending increases represent money well spent, said Kenneth Thorpe, a health policy researcher at Emory University who has focused on the cost of health care.

“It seems like we’re buying increases in survival,” Thorpe said.

The study is being published in Cancer, a medical journal of the American Cancer Society.

The researchers also found:

—The percentage of cancer costs from inpatient hospital care fell from 64 percent to about 27 percent. A shift to less expensive outpatient care, along with cost containment efforts by large health insurers, helped keep down increases in the costs per patient, the authors said.

—The proportion of cancer costs paid by private insurance rose from 42 to 50 percent.

—The proportion of costs paid out of pocket by patients — including copayments and deductibles — dropped from 17 percent to 8 percent.

Those last two findings surprised some experts.

Recent government reports have found that the percentage of Americans with private health insurance has been shrinking and recently hit its lowest mark in 50 years. Yet the study found that the proportion of cancer treatment costs paid by private insurance rose.

And companies have been tightening or cutting employee benefits, causing out-of-pocket costs to go up for many patients. Yet the study found that the proportion of bills paid by patients declined.

That last finding in particular was striking, said Lichtenfeld, the cancer society’s deputy chief medical officer.

He alluded to widely reported increases in personal bankruptcies prompted by medical bills. “There’s no question that the out-of-pocket costs for some patients have risen dramatically,” Lichtenfeld said.


The rising price of certain treatments also should be acknowledged, he said.

The challenge of rising prices was recognized by American Society of Clinical Oncology (ASCO), which last year released its first guidelines counseling cancer doctors on how to talk to patients about deciding between less expensive chemotherapy drugs made more sense than newer, more expensive products.

The study did not add in the cost of diagnostic tests and scans, which are cost drivers. And the data does not include the last five years, which saw some extremely pricey cancer drugs come on the market.

The picture may have changed since the study’s data was collected and the U.S. economy deteriorated, said Dr. Neal Meropol, a Case Western Reserve University cancer expert who worked on the ASCO guidelines.

Newer treatments along with wider testing are driving up the overall cost of cancer care, Meropol said.

“My concern is that costs are getting shifted to patients and there is a potential for increasing disparities” in cancer care, he added.

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