Disparities In Cancer Care And Costs At The End Of Life: Evidence From England’s National Health Service

Abstract

In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments.

Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis

“…There was some evidence that factors generating the observed inequalities in universal health care systems differed from those in market-based health care systems. For example, in the Swedish study by Hanratty and colleagues, patients with high SES had a higher median number of hospital bed days [30], which contrasted the higher inpatient costs associated with low SES patients found in other studies [24,35,41]. This suggests a higher use of hospital care in Sweden for higher SES patients that was not present in other countries.…”

“…Low SES was associated with higher total cost and also 11% higher non-emergent hospital expenditure in the last year of life, in contrast to studies that did not adjust for comorbidities [24]. Low SES patients incurred a higher total hospital cost (acute and elective) in the last six months of life largely due to higher acute rather than elective inpatient care costs [41]. They also had higher inpatient expenses in the last month of life [35].…”

Geographical disparities in treatment and health care costs for end-of-life cancer patients in China: a retrospective study

“…Previous research on EOL medical costs has focused on developed countries, such as United States [13–18], England [19–23], Australia [10, 24] and Canada [16, 25], with few studies of EOL medical costs in emerging and developing countries. Also, previous research on the medical costs of EOL care identified socioeconomic disparities, such as racial [15] and geographic disparities [14, 15], and different EOL treatment regimes [26], including inpatient care [10, 15, 17, 20, 23], outpatient care [14, 26] and hospice care [16, 22, 25].…”

“…Previous studies also found that patients’ age [24], place of residence [14], nationality [15] and treatment [27] were associated with end-of-life resource use and costs. Besides a developed country bias, previous EOL cancer cost studies have frequently used data not collected to answer specific EOL cost questions [20] and heavily relied on publicly available data sets [16, 19, 25–29]. We address both these short-comings, utilizing a specific EOL cancer survey for industrializing China.…”

Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

“…A previous study 26 found that high-cost end-of-life cancer expenditures are primarily associated with emergency and inpatient care. In 2010, the United States had the highest incidence of intensive care unit admissions and hospital expenditures for patients with cancer older than 65 years who died of cancer across 7 developed countries.…”