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Study Finds United States Ranks First in Health-Care Spending, but Cancer Outcomes Do Not Reflect the Investment

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Key Points

  • High health-care spending did not correlate with better outcomes and lower mortality in colorectal cancer and all cancers.
  • State-level socioeconomic status and wealth does have a positive impact on cancer outcomes and mortality.
  • The only cancer type in which high health-care spending led to lower mortality/incidence was breast cancer. The authors suggest that this finding potentially indicates the effectiveness of screening mechanisms, navigator programs, and advocacy organizations, among other initiatives at the state level.

The U.S. health-care system is characterized—on a global level—by its unsustainable spending, which does not necessarily correlate to better outcomes in patients with cancer. With $2.9 trillion spent in 2013, the United States ranks first in health-care spending among the world’s leading economies.

To investigate the implications of socioeconomic status and health expenditures on cancer outcomes and mortality, researchers at The University of Texas MD Anderson Cancer Center led by Jad Chahoud, MD, conducted an ecological study at the state level for three distinct patient populations: breast cancer, colorectal cancer, and all-cancer populations. Dr. Chahoud and colleagues found that high health-care spending did not correlate with better outcomes and lower mortality in colorectal cancer and all cancers, but that state-level socioeconomic status and wealth does have a positive impact on cancer outcomes and mortality.

The study was published by Chahoud et al in JNCCN—Journal of the National Comprehensive Cancer Network.

“Our work provides a new perspective on cancer outcomes disparities in the United States, laying the groundwork for future research to assess the effect of the Affordable Care Act on cancer outcomes across states,” said Dr. Chahoud.

Study Details

Dr. Chahoud and colleagues extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the National Cancer Institute, the investigators retrieved breast, colorectal, and all-cancer age-adjusted rates and computed mortality/incidence ratios for each population. In addition to the association between GDP and lower mortality/incidence, the data showed a rift between northern and southern states in all three patient populations, with patients in southern states faring worse.

“Our study highlights regional disparities in terms of financial and cancer outcomes, indicating a potential inefficient allocation of resources in the efforts against cancer,” said Dr. Chahoud.

According to the study, the only cancer type in which high health-care spending led to lower mortality/incidence was breast cancer. The authors suggest that this finding potentially indicates the effectiveness of screening mechanisms, navigator programs, and advocacy organizations, among other initiatives at the state level.

However, in one of a pair of complementary point/counterpoint editorials in the same issue, Melissa A. Simon, MD, MPH, and colleagues from Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Rush University, warn against allowing the data to guide—or misguide—policy makers in states that have high health expenditures to cap or decrease spending for certain health issues.

“Increased spending does not necessarily improve quality of care, but capping or cutting spending on health care does not necessarily solve problems either,” Dr. Simon noted.

Dr. Simon and colleagues’ editorial further notes that the data in this study predate the Affordable Care Act and describes the need for further study and analysis to inform the “the complicated interplay of wealth, health expenditures, and their relationship to cancer screening.”

In the counterpoint, Dr. Chahoud and colleagues agree on that need. “The goal of our study is not to misguide policy makers; instead it is to highlight a problem of disparity and to fuel the discussion at the national level,” responded Dr. Chahoud. “We are not recommending the ‘capping’ of health care spending. Instead, we are advocating for smart spending because complementing financial resources with other community-based and low-cost preventive measures is critical, especially in prevalent cancers, such as breast and colorectal.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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