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Out-of-Pocket Expenditure for Health Services at End-of-Life among Elderly People who died of Cancer
Researchers: Aviad Tur-Sinai1, Netta Bentur2, Damien Urban3, Jennifer Shuldiner4
- Yezreel Valley College
- Tel-Aviv University
- Sheba Medical Center
- University of Toronto
Background: While the impact of cancer on public expenditure is well known, hardly any information exists about out-of-pocket expenditure of cancer patients and their families, their economic burden, and their involvement in medical decisions making.
Objectives: (a) To examine the probability and level of out-of-pocket expenditure among persons who die from cancer and their families;
(b) To identify the main expenditures and examine the financial burden that they create;
(c) To examine the involvement of patients and their families in decisions making about out-of-pocket expenditure.
(b) To identify the main expenditures and examine the financial burden that they create;
(c) To examine the involvement of patients and their families in decisions making about out-of-pocket expenditure.
Method: Secondary analysis from the SHARE database, and a telephone survey among 491 family members of persons who died from cancer in Israel.
Findings: Some 84% of persons who died from cancer and their families incurred out-of-pocket expenditure for care in the patient’s last half-year of life; 27% for a nursing caregiver, 9% for a nurse, and 42% for medications. Most incurred additional expenditures as well. Among those who had out-of-pocket expenditure, average expenditures were NIS 26,000 for private caretaker, and NIS19,000 for medications. Roughly half of the family members described the economic burden of out-of-pocket expenditure as very severe, and it was related to the patients' lower functional status and lower economic situation. According to one-half of family members, doctors did not share with them the considerations for prescribing out-of-pocket medications.
Conclusions: Out-of-pocket expenditure for medical services is very common among persons who die from cancer and places a heavy economic burden on them. The involvement of patients and family members in end-of-life care decisions is incomplete and deficient.
Recommendations: There is a need to consider:
a. Consider ways of reducing copayment and out-of-pocket expenditure among patients with serious illnesses.
b. Expand information and explanations for patients and their families and enhance their involvement in decisions making in accordance with their preferences.
c. Include palliative care in early stages of incurable illnesses and enhance awareness of its advantages.
a. Consider ways of reducing copayment and out-of-pocket expenditure among patients with serious illnesses.
b. Expand information and explanations for patients and their families and enhance their involvement in decisions making in accordance with their preferences.
c. Include palliative care in early stages of incurable illnesses and enhance awareness of its advantages.
Research number: R/42/2017
Research end date: 06/2020