Abstract
Using nine biannual waves (1998–2014) from the Health and Retirement Study, this study employed fixed-effects models to estimate the relationship between cancer and changes in financial status, measured by liquidity, solvency, and investment ratios. Results show that cancer survivors in the initial stage of cancer care increased their emergency fund equivalent to 15 days of living expenses, along with an increase in their debt to asset ratio by 0.8%, and a decrease of investment asset to net worth ratio by 0.4%. Furthermore, two additional years of post-cancer care and rehabilitation lead to an increase of five more days in emergency cash need and a decrease in investment asset to net worth ratio by 0.3%.
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Notes
HRS measure of psychiatric problems is defined as general psychiatric conditions or problems, including Alzheimer’s disease, a common cause of death of older people in western societies according to Center for Disease Control and Prevention (2016). Specifically, in waves 1998–2008, HRS measure of psychiatric problem included Alzheimer’s disease. Starting 2010, HRS added a separate question of dementia along with the original question on general psychiatric condition. For consistency, this study used the question of general psychiatric condition across all waves to create the variable of psychiatric problems.
References
American Cancer Society (2016). Cancer facts and figures. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf.
American Cancer Society (2017). The costs of cancer: Addressing patient costs. Retrieved from https://www.acscan.org/policy-resources/costs-cancer.
Arozullah, A. M., Calhoun, E. A., Wolf, M., Finley, D. K., Fitzner, K. A., Heckinger, E. A., … Bennett, C. L. (2004). The financial burden of cancer: Estimates from a study of insured women with breast cancer. Journal of Supportive Oncology, 2, 271–278. https://doi.org/10.1186/1475-9276-11-60.
Ashenfelter, O. C., Zimmerman, D., & Levine, P. (2002). Statistics and econometrics from A to Z. New York: Wiley.
Avalere (2012). Total cost of cancer care by site of service: Physician office vs outpatient hospital. Retrieved from https://www.communityoncology.org/pdfs/avalere-cost-of-cancer-care-study.pdf.
Babiarz, P., Widdows, R., & Yilmazer, T. (2013). Borrowing to cope with adverse health events: Liquidity constraints, insurance coverage, and unsecured debt. Health Economics, 22, 1177–1198. https://doi.org/10.1002/hec.2877.
Baek, E., & DeVaney, S. A. (2004). Assessing the baby boomers’ financial wellness using financial ratios and a subjective measure. Family and Consumer Sciences Research Journal, 32, 321–348. https://doi.org/10.1177/1077727x04263826.
Barlow, W. E., Taplin, S. H., Yoshida, C. K., Buist, D. S., Seger, D., & Brown, M. (2001). Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. Journal of the National Cancer Institute, 93, 447–455.
Beasley, D. (2017). The cost of cancer: New drugs show success at a steep price. Reuters. Retrieved from https://www.reuters.com/article/us-usa-healthcare-cancer-costs/the-cost-of-cancer-new-drugs-show-success-at-a-steep-price-idUSKBN1750FU.
Bennett, K. J., & Dismuke, C. E. (2010). Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income. Journal of Health Care or the Poor and Underserved, 21, 691–703. https://doi.org/10.1353/hpu.0.0309.
Blumen, H., Fitch, K., & Polkus, V. (2016). Comparison of treatment costs for breast cancer, by tumor stage and type of service. American Health Drug Benefits, 9, 23–32.
Briys, E., & Schlesinger, H. (1990). Risk aversion and the propensities for self-insurance and self-protection. Southern Economic Journal, 57, 458–467.
Brown, M. L., Riley, G. F., Schussler, N., & Etzioni, R. (2002). Estimating health care costs related to cancer treatment from SEER-medicare data. Medical Care, 40, 104–117. https://doi.org/10.1097/01.MLR.0000020939.20666.47.
Campbell, J. D., & Ramsey, S. D. (2009). The costs of treating breast cancer in the US. Pharmacoeconomics, 27, 199–209. https://doi.org/10.2165/00019053-200927030-00003.
Center for Disease Control and Prevention. (2016). Leading causes of death. Retrieved from http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
Community Oncology Alliance (2016). 2016 Community oncology practice impact report: Tracking the changing landscape of cancer care. Retrieved from https://www.communityoncology.org/wp-content/uploads/2016/09/PracticeImpactReport-2016-Report.pdf.
Congressional Budget Office Cost Estimate (2017). H.R. 1628 Obamacare repeal reconciliation act of 2017. Retrieved from https://www.cbo.gov/publication/52939.
Conti, R. M., & Bach, P. B. (2013). Cost consequences of the 340B drug discount program. The Journal of the American Medical Association, 309, 1995–1996. https://doi.org/10.1001/jama.2013.4156.
De Souza, J. A., & Conti, R. M. (2017). Mitigating financial toxicity among us patients with cancer. The Journal of the American Medical Association: Oncology, 3, 765–766. https://doi.org/10.1001/jamaoncol.2016.4850.
Dixon, W. (1960). Simplified estimation from censored normal samples. The Annals of Mathematical Statistics, 31, 385–391.
Doshi, J. A., Li, P., Huo, H., Pettit, A. R., & Armstrong, K. A. (2018). Association of patient out-of-pocket costs with prescription abandonment and delay in fills of novel oral anticancer agents. Journal of Clinical Oncology, 36, 476–482. https://doi.org/10.1200/JCO.2017.74.5091.
Dowling, E. C., Chawla, N., Forsythe, L. P., de Moor, J., McNeel, T., Rozjabek, H. M., … Yabroff, K. R. (2013). Lost productivity and burden of illness in cancer survivors with and without other chronic conditions. Cancer, 119, 3393–3401. https://doi.org/10.1002/cncr.28214.
Dusetzina, S. B., Basch, E., & Keating, N. L. (2015). For uninsured cancer patients, outpatient charges can be costly, putting treatments out of reach. Health Affairs, 34, 584–591. https://doi.org/10.1377/hlthaff.2014.0801.
Evidence-based Synthesis Program (2010). Comparison of quality of care in VA and non-VA settings: A systematic review. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK49108/pdf/Bookshelf_NBK49108.pdf.
Finkelstein, E. A., Tangka, F. K., Trogdon, J. G., Sabatino, S. A., & Richardson, L. C. (2009). The personal financial burden of cancer for the working–aged population. The American Journal of Managed Care, 15, 801–806. https://doi.org/10.1016/j.apmr.2009.02.020.
Fitch, K., Pelizzari, P. M., & Bruce Pyenson, F. S. A. (2016). Cost Drivers of cancer care: A retrospective analysis of medicare and commercially insured population claim data 2004–2014. Retrieved from http://www.milliman.com/uploadedFiles/insight/2016/trends-in-cancer-care.pdf.
French, E., & Jones, J. B. (2011). The Effects of health insurance and self-insurance on retirement behavior. Econometrica, 79, 693–732. https://doi.org/10.3982/ecta7560.
Garman, E. T., & Forgue, R. (2015). Personal finance (12th edn.). Boston: Cengage Learning.
Gilligan, A. M. (2013. Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement Study. Retrieved from http://hdl.handle.net/10150/293483.
Gordon, N., Stemmer, S. M., Greenberg, D., & Goldstein, D. A. (2018). Trajectories of injectable cancer drug costs after launch in the United States. Journal of Clinical Oncology, 36, 319–325. https://doi.org/10.1200/JCO.2016.72.2124.
Greninger, S. (1996). Ratios and benchmarks for measuring the financial well-being of families and individuals. Financial Services Review, 5, 57–70. https://doi.org/10.1016/s1057-0810(96)90027-x.
Harness, N., Finke, M., & Chatterjee, S. (2008). Household financial ratios: A review of literature. Journal of Personal Finance, 6, 77–97.
Hauser, R. M., & Willis, R. J. (2004). Survey design and methodology in the Health and Retirement Study and the Wisconsin Longitudinal Study. Population and Development Review, 30, 209–235. https://doi.org/10.7826/isr-um.06.585031.001.05.0012.2005.
Hayes, J., Hoverman, R. J., Brow, M. E., Dilbeck, D. C., Verrilli, D. K., Garey, J., … Beveridge, R. (2015). Cost differential by site of service for cancer patients receiving chemotherapy. The American Journal of Managed Care, 21, e189–e196.
Health and Retirement Study (1998). Sample evolution: 1992–1998. Retrieved from http://hrsonline.isr.umich.edu/sitedocs/surveydesign.pdf.
Health and Retirement Study (2017). Aging in the 21st century: Challenges and opportunities for Americans. Retrieved from http://hrsonline.isr.umich.edu/sitedocs/databook/inc/pdf/HRS-Aging-in-the-21St-Century.pdf.
Hensley, M. L., Dowell, J., & Herndon, J. E., 2nd (2005). Economic outcomes of breast cancer survivorship: CALGB study 79804. Breast Cancer Research and Treatment, 91, 153–161. et al.
Horrigan, J. O. (1965). Some empirical bases of financial ratio analysis. The Accounting Review, 40, 558–568.
Howard, D. H., Bach, P. B., Berndt, E. R., & Conti, R. M. (2015). Pricing in the market for anticancer drugs. The Journal of Economic Perspectives, 29, 139–162. https://doi.org/10.3386/w20867.
Howlader, N., Noone, A. M., Krapcho, M., Miller, D., Bishop, K., Kosary, C. L., & Cronin, K. A. (2017). National Cancer Institute Cancer Statistics Review, 1975–2014. Retrieved from https://seer.cancer.gov/csr/1975_2014.
Jagsi, R., Pottow, J. A., Griffith, K. A., Bradley, C., Hamilton, A. S., Graff, J., … Hawley, S. T. (2014). Long-term financial burden of breast cancer: Experiences of a diverse cohort of survivors identified through population-based registries. Journal of Clinical Oncology, 32, 1269–1276. https://doi.org/10.1200/JCO.2013.53.0956.
Kahana, E., Deimling, G. T., Rose, J. H., Bowman, K. F., & Miller, R. H. (2006). Cancer in the elderly. Transactions of The American Clinical and Climatological Association, 117, 147–156.
Kantarjian, H., & Chapman, R. (2015). Value of the 340B drug discount program. The Journal of the American Medical Association:Oncology, 1, 1029–1030. https://doi.org/10.1001/jamaoncol.2015.2168.
Kim, H., & Lyons, A. C. (2008). No pain, no strain: Impact of health on the financial security of older Americans. The Journal of Consumer Affairs, 42, 9–36. https://doi.org/10.2139/ssrn.985891.
Kim, T. K., & Wilmarth, M. J. (2016). Government subsidies and household debt burden after the great recession. Journal of Family Economic Issues, 37, 349–358. https://doi.org/10.1007/s10834-016-9492-5.
Lytton, R. H., Garman, E. T., & Porter, N. M. (1991). How to use financial ratios when advising clients. Financial Counseling and Planning, 2, 3–23.
Malek, K. S., & Silliman, R. A. (2007). Cancer survivorship issues in older adults. In P. A. Ganz (Ed.), Cancer survivorship: Today and tomorrow (pp. 215–224). New York: Springer.
Medbery, R. L., Perez, S. D., Force, S. D., Gillespie, T. W., Pickens, A., Miller, D. L., & Fernandez, F. G. (2014). Video-assisted thoracic surgery lobectomy cost variability: Implications for a bundled payment era. The Annals of Thoracic Surgery, 97, 1686–1693. https://doi.org/10.1016/j.athoracsur.2014.01.021.
Narang, A. K., & Nicholas, L. H. (2016). Out-of-pocket spending and financial burden among Medicare beneficiaries with cancer. The Journal of the American Medical Association: Oncology, 23, E1–E8. https://doi.org/10.1001/jamaoncol.2016.4865.
Nelson, R. (2015). Large cost variations for radiotherapy in medicare patients. Medscape. Retrieved from https://www.medscape.com/viewarticle/849474.
Newhouse, J. P., Garber, A. M., Graham, R. P., McCoy, M. A., Mancher, M., & Kibria, A., & (Eds.). (2013). Variation in health care spending: Target decision making, not geography. Washington, DC: National Academies Press. https://doi.org/10.17226/18393.
Nielsen, R. B., Zick, C. D., Mayer, R. N., & Smith, K. R. (2001). Genetic testing and the demand for cancer insurance. Journal of Consumer Policy, 24, 1–21. https://doi.org/10.1023/a:1010987110208.
Paravati, A. J., Boero, I. J., Triplett, D. P., Hwang, L., Matsuno, R. K., Xu, B., … Murphy, J. D. (2015). Variation in the cost of radiation therapy among medicare patients with cancer. Journal of Oncology Practice, 11, 403–409. https://doi.org/10.1200/JOP.2015.005694.
Pate, S. C., Uhlman, M. A., Rosenthal, J. A., Cram, P., & Erickson, B. A. (2014). Variations in the open market costs for prostate cancer surgery: A survey of US hospitals. Urology, 83, 626–631. https://doi.org/10.1016/j.urology.2013.09.066.
Pumkam, C., Probst, J. C., Bennett, K. J., Hardin, J., & Xirasagar, S. (2013). Health care expenditures among working-age adults with physical disabilities: Variations by disability spans. Disability and Health Journal, 6, 287–296. https://doi.org/10.1016/j.dhjo.2013.03.002.
RAND. (2016). HRS data, version P. Produced by the RAND Center for the Study of Aging, with funding from the National Institute on Aging and the Social Security Administration. Santa Monica: RAND.
Roxanne, N. (2016) Community Oncology clinics still under siege, says COA REPORT. Medscape. Retrieved from https://www.medscape.com/viewarticle/869985#vp_1.
Shankaran, V., Jolly, S., Blough, D., & Ramsey, S. D. (2012). Risk factors for financial hardship in patientcancer survivors receiving adjuvant chemotherapy for colon cancer: A population-based exploratory analysis. Journal of Clinical Oncology, 30, 1608–1614. https://doi.org/10.1200/JCO.2011.37.9511.
Short, P. F., Vasey, J. J., & Moran, J. R. (2008). Long-term effects of cancer survivorship on the employment of older workers. Health Services Research, 43, 193–210. https://doi.org/10.1111/j.1475-6773.2007.00752.
Smith, S. K., Nicolla, J., & Zafar, S. Y. (2014). Bridging the gap between financial distress and available resources for patients with cancer: A qualitative study. Journal of Oncology Practice, 10, e368–e372. https://doi.org/10.1200/JOP.2013.001342.
Soneji, S., & Yang, J. (2015). New analysis reexamines the value of cancer care in the United States compared to Western Europe. Health Affairs, 34, 390–397. https://doi.org/10.1377/hlthaff.2014.0174.
Starr-McCluer, M. (1996). Health insurance and precautionary savings. American Economic Review, 86, 285–295.
Stokes, M. E., Ishak, J., Proskorovsky, I., Black, L. K., & Huang, Y. (2011). Lifetime economic burden of prostate cancer. BMC Health Services Research, 11, 349–355. https://doi.org/10.1186/1472-6963-11-349.
Walling, A. M., Tisnado, D., Asch, S. M., Malin, J. M., Pantoja, P., Dy, S. M., … Lorenz, K. A. (2013). The quality of supportive cancer care in the veterans affairs health system and targets for improvement. The Journal of the American Medical Association: Internal Medicine, 173, 2071–2079. https://doi.org/10.1001/jamainternmed.2013.10797.
Winger, B. J., & Frasca, R. R. (2000). Personal finance: An integrated planning approach. Upper Saddle River: Prentice Hall.
Wooldridge, J. M. (2002). Econometric analysis of cross section and panel data. Cambridge: MIT Press.
Yabroff, K. R., Warren, J. L., Schrag, D., Mariotto, A., Meekins, A., Topor, M., & Brown, M. L. (2009). Comparison of approaches for estimating incidence costs of care for colorectal cancer patients. Medical Care, 47, S56–S63. https://doi.org/10.1097/mlr.0b013e3181a4f482.
Yao, R., Hanna, S. D., & Montalto, C. P. (2003). The capital accumulation ratio as an indicator of retirement adequacy. Financial Counseling and Planning, 14, 1–11.
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Radion Svynarenko, Qun Zhang, and Hyungsoo Kim declare that they have no conflict of interest.
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Svynarenko, R., Zhang, Q. & Kim, H. The Financial Burden of Cancer: Financial Ratio Analysis. J Fam Econ Iss 40, 165–179 (2019). https://doi.org/10.1007/s10834-018-9587-2
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DOI: https://doi.org/10.1007/s10834-018-9587-2