Medicaid Expenditures for Cancer: Evidence from Medicaid-only Beneficiaries in Four States

This study estimates the cost burden of 6 prevalent invasive cancers—breast, cervical, colorectal, lung, melanoma, and prostate—on Medicaid programs in 4 states. The analyses use Medicaid claims and enrollment data for all Medicaid-only beneficiaries over age 18 in Georgia, Illinois, Louisiana, and Maine with at least 1 month of enrollment in fee-for-service Medicaid from 2000 to 2003. We applied ordinary least squares regression analysis to a data set created from Medicaid claims and enrollment data to estimate annual expenditures attributable to each cancer after controlling for age, race, gender, and comorbid conditions. Cancers and comorbid conditions were identified on the basis of claims with an appropriate diagnosis code. Cancers include both incident and prevalent cases. In 2003 dollars, annualized Medicaid expenditures attributable to the 6 cancers combined in the Medicaid-only population were $84.0 million in Georgia,$79.7 million in Illinois, $51.4 million in Louisiana, and$29.4 million in Maine. Attributable annualized per-capita Medicaid expenditures were highest for lung cancer, then colorectal cancer. After adjusting for sociodemographics and comorbidities, only 10% to 50% of medical expenditures among Medicaid-only beneficiaries with cancer were attributable to cancer. Estimates of the costs of care for Medicaid-eligible cancer patients are critical to understanding the implications of cancer for state and federal budgets. The Patient Protection and Affordable Care Act (ACA) of 2010 is expected to substantially expand the adult Medicaid population. These estimates provide important baseline information for assessing the potential effects of increased Medicaid enrollment on Medicaid expenditures for cancer

Medical Care Costs of Breast Cancer in Privately Insured Women Aged 18–44 Years

Breast cancer in women aged 18–44 years accounts for approximately 27,000 newly diagnosed cases and 3,000 deaths annually. When tumors are diagnosed, they are usually aggressive, resulting in expensive treatment costs. The purpose of this study is to estimate the prevalent medical costs attributable to breast cancer treatment among privately insured younger women

Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina

Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population’s health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina

Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States)

OBJECTIVE: To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women. METHODS: Low-income, uninsured women aged 40–64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program. RESULTS: In 2002–2003, of all U.S. women aged 40–64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%. CONCLUSIONS: Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40–64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population

Costs of Chronic Diseases at the State Level: The Chronic Disease Cost Calculator

IntroductionMany studies have estimated national chronic disease costs, but state-level estimates are limited. The Centers for Disease Control and Prevention developed the Chronic Disease Cost Calculator (CDCC), which estimates state-level costs for arthritis, asthma, cancer, congestive heart failure, coronary heart disease, hypertension, stroke, other heart diseases, depression, and diabetes.MethodsUsing publicly available and restricted secondary data from multiple national data sets from 2004 through 2008, disease-attributable annual per-person medical and absenteeism costs were estimated. Total state medical and absenteeism costs were derived by multiplying per person costs from regressions by the number of people in the state treated for each disease. Medical costs were estimated for all payers and separately for Medicaid, Medicare, and private insurers. Projected medical costs for all payers (2010 through 2020) were calculated using medical costs and projected state population counts.ResultsMedian state-specific medical costs ranged from $410 million (asthma) to$1.8 billion (diabetes); median absenteeism costs ranged from $5 million (congestive heart failure) to$217 million (arthritis).ConclusionCDCC provides methodologically rigorous chronic disease cost estimates. These estimates highlight possible areas of cost savings achievable through targeted prevention efforts or research into new interventions and treatments

Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population

Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003–2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations

Implications of feed scarcity for gender roles in ruminant livestock production

Gender division of labor in ruminant livestock production systems varies across regions according to economic, socio-cultural factors. There is a distinct age and sex division of work in pastoral (nomadic and sedentary) systems. Men are in charge of general herd management and selling of livestock. Women carry out dairy-related activities and manage vulnerable animals (calves; small ruminants; sick, injured and pregnant animals). Children undertake most of the routine work such as herding. In the mixed systems both men and women take part in animal husbandry activities such as harvesting and transportation of feed, chaffing of fodder, feeding of animals, milking, cleaning of sheds and sale of milk. Their degrees of involvement in each activity vary from place to place. Processing of milk is solely women’s job. Children of both sexes tether and herd animals. Like in animal husbandry activities, crop cultivation tasks are shared among household members and also vary across regions. Feed scarcity increase work burden of all household members, but more for women and children in many situations. Feed scarcity reduces livestock, crop and non-farm productivity. It reduces availability and access to food, via decreased food supply and incomes and hence reduces food and nutrition security and consequently human welfare