JAMA Study: AI/AN Cancer Patients Have Higher Medicare Spending, Worse Outcomes

American Indian and Alaska Native Medicare beneficiaries diagnosed with cancer face steeper health care spending alongside significantly higher all-cause mortality rates compared to the general Medicare population, according to research published in the journal JAMA Network Open. Across traditional Medicare claims evaluated between January 1, 2016, and December 31, 2023, the study tracks stark disparities in utilization, out-of-pocket costs, and clinical outcomes for Indigenous patients.

Indigenous Cancer Patients Face Higher Medicare Costs

In 2023, mean spending for American Indian and Alaska Native beneficiaries with cancer reached $32,775 per person in allowed payments, with an estimated out-of-pocket cost of $5,970 per person. For the general population of Medicare beneficiaries with cancer, those figures stood lower at $25,073 in allowed payments and $4,779 in out-of-pocket costs. The study sample for 2023 included 26,867,866 total Medicare beneficiaries, of whom 123,597, or 0.46%, identified as American Indian or Alaska Native.

The proportion of beneficiaries under 65 years of age was significantly higher in the American Indian and Alaska Native group at 24.9%, compared to 4.1% in the general population. Furthermore, 40.1% of American Indian and Alaska Native beneficiaries qualified for Medicare through disability or end-stage renal disease, compared to 17.8% overall, while 40.3% qualified as dual-eligible for Medicaid, compared to 15.3% in the general population.

Indigenous Patients Rely More on Acute Care

Clinical utilization patterns show that Indigenous cancer patients rely more heavily on acute care settings. American Indian and Alaska Native beneficiaries experienced higher rates of inpatient admissions at 31.6% compared to 22.7% for overall beneficiaries. Intensive care unit admissions reached 6.8% versus 4.3%, and emergency department visits hit 29.7% compared to 19.9% in the broader population.

At the same time, preventive screening rates lagged behind. The relative risk of obtaining a breast cancer screening was 0.61 for American Indian and Alaska Native beneficiaries compared to the general Medicare population, while colorectal cancer screening registered a relative risk of 0.60. End-of-life care metrics also differed, with 57.2% of American Indian and Alaska Native beneficiaries utilizing hospice care, compared with 65.6% of beneficiaries overall.

Mortality Disparities Across Specific Cancers

The 2023 all-cause mortality rate reached 12.4% among American Indian and Alaska Native beneficiaries, nearly double the 6.9% rate recorded for the general Medicare population. Researchers reported elevated mortality specifically for lung cancer, pancreatic cancer, bladder cancer, and melanoma among Indigenous patients.

These findings suggest American Indian and Alaska Native beneficiaries with cancer have worse health and may face difficulties accessing health care services.

Study Researchers

Funding for the research came from the Department of Energy via the Oak Ridge Institute for Science and Education, as well as congressional backing directed to the Office of Health Policy—part of the Office of the Assistant Secretary of Planning and Evaluation under the Office of the Secretary of Health and Human Services. One study author disclosed conflicts of interest.

Authors Call for Comprehensive Infrastructure Interventions

The study authors concluded that closing the gaps for American Indian and Alaska Native beneficiaries demands broad changes across the medical, socioeconomic, and cultural frameworks backing this group. Additional studies and partnerships with tribes are essential to connect these broad patterns with clinical results and cancer patients within American Indian and Alaska Native populations.