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Impact of time of diagnosis on out-of-pocket costs of cancer treatment, a side effect of health insurance design in Australia

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  • Naghsh-Nejad, Maryam
  • van Gool, Kees

Abstract

The Extended Medicare Safety Net (EMSN) in Australia was designed to provide financial assistance to patients with high out-of-pocket (OOP) costs for medical treatment. The EMSN works on a calendar year basis. Once a patient incurs a specified amount of OOP costs, the EMSN provides additional financial benefits for the remainder of the calendar year. Its design is similar to many types of insurance products that have large deductibles and are applied on a calendar year basis. This study examines if the annual quarter within which a patient is diagnosed with cancer has an impact on the OOP costs incurred for treatment. We use administrative linked data from the Sax Institute's 45 and Up Study. Our results indicate that the timing of cancer diagnosis has a significant impact on OOP costs. Specifically, patients diagnosed in the fourth quarter of the calendar year experience significantly higher OOP costs compared to those diagnosed in the first quarter of the year. This pattern persists after controlling for different types of cancer and different stages of cancer and robustness checks. These findings have important implications for the design of the EMSN, as well as other insurance products.

Suggested Citation

  • Naghsh-Nejad, Maryam & van Gool, Kees, 2024. "Impact of time of diagnosis on out-of-pocket costs of cancer treatment, a side effect of health insurance design in Australia," Health Policy, Elsevier, vol. 145(C).
    • Handle: RePEc:eee:hepoli:v:145:y:2024:i:c:s0168851024000654
    DOI: 10.1016/j.healthpol.2024.105055
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    References listed on IDEAS

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    1. Yu, Serena & van Gool, Kees & Hall, Jane & Fiebig, Denzil G., 2019. "Physician pricing behavior: Evidence from an Australian experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 161(C), pages 20-34.
    2. Meliyanni Johar & Chunzhou Mu & Kees Van Gool & Chun Yee Wong, 2017. "Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 528-535, April.
    3. Nicole Bates & Emily Callander & Daniel Lindsay & Kerrianne Watt, 2018. "CancerCostMod: a model of the healthcare expenditure, patient resource use, and patient co-payment costs for Australian cancer patients," Health Economics Review, Springer, vol. 8(1), pages 1-12, December.
    4. Kees Van Gool & Elizabeth Savage & Rosalie Viney & Marion Haas & Rob Anderson, 2009. "Who's Getting Caught? An Analysis of the Australian Medicare Safety Net," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 42(2), pages 143-154, June.
    Full references (including those not matched with items on IDEAS)

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    More about this item

    Keywords

    Out of pocket costs; Cancer; Public health insurance;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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