Hospital Type and Utilization, Prices, and Financial Burden of Cancer Surgeries in the United States

In this initiative, PC3I researchers examined the relationship between hospital types and utilization, prices and financial burden, and spending for major cancer surgeries among privately insured patients in the Commonwealth of Pennsylvania and across the United States. They explored the differences in utilization and spending associated with different types of hospital providers, ranging from community-based providers to academic health systems, to National Cancer Institute-designated cancer centers, or member institutions of the National Comprehensive Care Network. The research revealed new knowledge about health outcomes and financial burden experience by cancer patients treated in various hospital settings.

While prior research has examined spending variation for patients with cancer covered by Medicare, this is among the first to examine such variation for those covered by private insurance. Because prices are negotiated under private insurance contracts and not administered as they are under Medicare, this study fills an important gap in our understanding of insurer spending differences by hospital type. Findings demonstrated that surgery-specific and 90-day post-discharge spending were higher for patients undergoing surgery at National Cancer Institute-designated (NCI) cancer centers as compared with those receiving treatment at community hospitals. This could possibly be due to the size, market share and prestige of NCI centers, which could be leveraged in price negotiations. However, in spite of spending differences, there were no significant differences between NCI centers and community hospitals in post-discharge care utilization. To better understand whether the higher price of NCI centers is justified, it is important for future research to explore hospital-level differences in long-term post-surgical outcomes.

The Commonwealth of Pennsylvania Department of Health

Abramson Cancer Center (ACC) Cancer Control Program; Medical Oncology; Surgery; Radiation Oncology; The Wharton School; Leonard Davis Institute of Health Economics.