Steven R. Machlin

Prevalence and Costs of Skin Cancer Treatment in the U.S., 2002−2006 and 2007−2011

BACKGROUND Skin cancer, the most common cancer in the U.S., is a major public health problem. The incidence of nonmelanoma and melanoma skin cancer is increasing; however, little is known about the economic burden of treatment. PURPOSE To examine trends in the treated prevalence and treatment costs of nonmelanoma and melanoma skin cancers. METHODS This study used data on adults from the 2002-2011 Medical Expenditure Panel Survey full-year consolidated files and information from corresponding medical conditions and medical event files to estimate the treated prevalence and treatment cost of nonmelanoma skin cancer, melanoma skin cancer, and all other cancer sites. Analyses were conducted in January 2014. RESULTS The average annual number of adults treated for skin cancer increased from 3.4 million in 2002-2006 to 4.9 million in 2007-2011 (p<0.001). During this period, the average annual total cost for skin cancer increased from

Sensitivity of household reported medical conditions in the medical expenditure panel survey.

3.6 billion to

Access to Preventive Health Care for Cancer Survivors

8.1 billion (p=0.001), representing an increase of 126.2%, while the average annual total cost for all other cancers increased by 25.1%. During 2007-2011, nearly 5 million adults were treated for skin cancer annually, with average treatment costs of

Patterns of Survey Attrition and Reluctant Response in the 1996 Medical Expenditure Panel Survey

8.1 billion each year. CONCLUSIONS These findings demonstrate that the health and economic burden of skin cancer treatment is substantial and increasing. Such findings highlight the importance of skin cancer prevention efforts, which may result in future savings to the healthcare system.

Has the increase in HMO enrollment within the Medicaid population changed the pattern of health service use and expenditures

Introduction:Accurate survey data on medical conditions are critical for health care researchers. Although medical condition data are complex and are subject to reporting error, little information exists on the quality of household reported condition data. Methods:We used pooled data from 4 years (2002–2005) of the Medical Expenditure Panel Survey (MEPS) to estimate the extent to which household respondents may underreport 23 types of medical conditions. The medical expenditure panel survey is a nationally representative annual survey of approximately 15,000 households which collects medical condition information in 2 separate components—the Household Component (HC) and the Medical Provider Component (MPC). We computed sensitivity rates based on linked HC and MPC data under the assumption that if collection of medical conditions from household respondents was complete, then the conditions reported in the MPC would also be reported in the HC. Results:Sensitivity rates ranged from a high of 93.8% to a low of 37.4% and were 75% or higher for 10 of the 23 conditions analyzed. The overall sensitivity rate for the 23 conditions combined was 74%. Conclusions:Household reports tended to be more accurate for conditions that are highly salient, cause pain, require hospitalization, require ongoing treatment, have specific recognizable treatment, alter lifestyle, and/or affect daily life (eg, pregnancy, diabetes, and kidney stones). In addition, reporting generally was better when conditions are classified in broader categories rather than in more detail.

Patient-Centered Care Categorization of U.S. Health Care Expenditures

BACKGROUND Access to health care, particularly effective primary and secondary preventive care, is critical for cancer survivors, in order to minimize the adverse sequelae of cancer and its treatment. PURPOSE The goal of the study was to evaluate the association between cancer survivorship and access to primary and preventive health care. METHODS Cancer survivors (n=4960) and individuals without a cancer history (n=64,431) aged ≥ 18 years, from the 2008-2010 Medical Expenditure Panel Survey (MEPS), were evaluated. Multiple measures of access and preventive services use were compared. The association between cancer survivorship and access and preventive services was evaluated with multivariate logistic regression models, stratified by age group (18-64 years and ≥ 65 years), controlling for the effects of age, gender, race/ethnicity, education, marital status, and comorbidities. Data were analyzed in 2013. RESULTS Cancer survivors aged ≥ 65 years had equivalent or greater access and preventive services use than individuals without a cancer history, in adjusted analyses. However, among those aged 18-64 years with private health insurance, cancer survivors were more likely than other individuals to have a usual source of care and to use preventive services, whereas uninsured or publicly insured cancer survivors were generally less likely to have a usual source of care and to use preventive services than were uninsured or publicly insured adults without a cancer history. CONCLUSIONS Although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18-64 years suggest that improvements in survivor care are needed.

Estimates of Medical Expenditures from the Medical Expenditure Panel Survey: Gains in Precision from Combining Consecutive Years of Data

In panel designs with multiple waves of data collection, the overall survey response rate is a multiplicative function of the wave specific response rates. The 1996 Medical Expenditure Panel Survey (MEPS) follows this model, requiring five rounds of data collection with the same panel of sampled households, to acquire data on health care use, expenditures, insurance coverage and sources of payment that cover two consecutive calendar years. Gaining an understanding of the factors that distinguish the cooperative respondents, the survey participants that require use of nonresponse conversion techniques to maintain their cooperation (reluctant respondents), and the initial participants that eventually drop out of the survey (part-year respondents) is essential from both an estimation and data collection perspective. To inform the specification of nonresponse adjustment strategies in MEPS to correct for survey attrition, this study attempts to identify the characteristics that distinguish survey participants across rounds from the part-year respondents. In addition, the study identifies factors that distinguish the cooperative respondents, the reluctant respondents and the part-year respondents, to better inform the MEPS data collection effort. The investigation also examines the implications of a data collection strategy that would not convert initial survey refusals by studying the effect, on survey estimates and their precision, of excluding reluctant survey respondents.Our findings revealed that reluctant respondents in the first round of the survey were significantly more likely to become non-respondents in the second round. In addition, the round two non-respondents were also more likely to be located in large metropolitan areas, to reside in the larger households with 5 or more members, to be elderly, and more likely to be either married or separated. Many of these characteristics were similar to those found to be at higher risk for nonresponse to the round one interview. Reluctant respondents as a whole appear to be a distinctly separate group, sharing one set of characteristics with the cooperative respondent group, another set with those who refused during the second round of the survey, and yet a third set of characteristics that are uniquely their own. If no effort had been made to convert reluctant participants, the precision of our survey estimates would have declined, but not substantially.

Measuring inpatient care use in the United States: A comparison across five federal data sources

Objective. To describe changes in health services use and expenditures within the Medicaid population between 1987 and 1997 and to estimate the extent to which the increase in Health Maintenance Organization (HMO) enrollment has influenced these changes. Subjects. Individuals under the age of 65 years in the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey enrolled in Medicaid the entire year. Research Design. Using bivariate and multivariate techniques, we compared several measures of health services use and expenditures across three groups: (1) individuals enrolled in Medicaid for all of 1987; (2) individuals enrolled in Medicaid for all of 1997 but never enrolled in an HMO; and (3) individuals enrolled in Medicaid for all of 1997 and enrolled in an HMO for at least part of the year. Results. Medicaid enrollees in 1997 differ little from Medicaid recipients in 1987 with respect to use and expenditures. Modest but statistically significant differences emerge, however, when a distinction is made between HMO enrollees and non‐HMO enrollees in 1997. Specifically, 1997 Medicaid HMO enrollees have significantly fewer hospital visits than 1987 Medicaid enrollees and spend significantly less on health services than 1997 non‐HMO enrollees. Conclusions. Our findings suggest that the increase in HMO enrollment may have held down use and expenditures to rates modestly lower than what would have been expected had HMO enrollment not increased.

Nonresponse Adjustment Strategy in the Household Component of the 1996 Medical Expenditure Panel Survey

OBJECTIVE To categorize national medical expenditures into patient-centered categories. DATA SOURCES The 2007 Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the civilian noninstitutionalized population. STUDY DESIGN Descriptive statistics categorizing expenditures into seven patient-centered care categories: chronic conditions, acute illness, trauma/injury or poisoning, dental, pregnancy/birth-related, routine preventative health care, and other. DATA COLLECTION METHODS MEPS cohort. PRINCIPAL FINDINGS Nearly half of expenditures were for chronic conditions. The remaining expenditures were as follows: acute illness (25 percent), trauma/poisoning (8 percent), dental (7 percent), routine preventative health care (6 percent), pregnancy/birth-related (4 percent), and other (3 percent). Hospital-based expenditures accounted for the majority for acute illness, trauma/injury, and pregnancy/birth and over a third for chronic conditions. CONCLUSIONS This patient-centered viewpoint may complement other methods to examine health care expenditures and may better represent how patients interact with the health care system and expend resources.