Association of Sociodemographics with Out-of-Pocket Expenditure and Underinsurance in Skin Cancer Survivors

Background: The sociodemographic predictors of either out-of-pocket expenditure (OOP) or underinsurance among skin cancer survivors is not well reported in the literature. In this study we estimated all-cause healthcare related OOP expenditure and probability of underinsurance among insured skin cancer survivors and identified the sociodemographic predictors of these measures. Data and Method: We pooled Medical Expenditure Panel Survey (MEPS) data from 2011 to 2015 and identified skin cancer using Clinical Classifications Software (CCS) code. Only adult (≥18 years) skin cancer survivors with full year insurance coverage were included in our study (n = 1825). We used a generalized linear model (GLM) with log link and gamma distribution to estimate OOP and a logit model to estimate the probability of underinsurance. We estimated the Average Marginal Effect (AME) to quantify the variations and their statistical significance between reference level and other levels of each predictor. Our analyses accounted for the complex survey design of MEPS. Results: The average all-cause OOP was $1766 per person per year for a skin cancer survivor. Among all skin cancer survivors, females, those aged 60-64 years, with some college education or a degree, with income ≥400% of federal poverty level (FPL) and with non-managed-care private insurance incurred significantly higher OOP expenditure compared to their respective counterparts. In terms of underinsurance, females and those aged 60-64 years had higher probability, whereas, survivors with non-white race/ethnicity and income 200% of FPL or higher had lower probability of being underinsured compared to their respective counterparts. Conclusion: Our study demonstrates that OOP expenditure and underinsurance varies significantly by sociodemographic factors among skin cancer survivors.