Medicare expenditures are lower for rural beneficiaries with cancer than urban beneficiaries, found a recent study.1

“Cancer is a significant cost-driver for insurers. Cancer patients are often a larger proportion of high-cost recipients,” notes Elizabeth Crouch, PhD, the study’s lead author.

Researchers analyzed utilization and expenditures for Medicare beneficiaries with breast, lung, or colorectal cancer in the last six months of life. For each type of cancer, total expenditures were lower for rural decedents compared to their urban counterparts.

“Increasing incidence and prevalence rates of cancer, combined with new and costlier cancer treatments, have patients, insurers, and policymakers alike concerned with the availability and provision of affordable, high-quality care for cancer patients,” says Crouch, an assistant professor in the department of health services policy and management at the University of South Carolina in Columbia.

Rural cancer patients face limited access to most healthcare services — especially palliative care — compared to urban cancer patients. “Hospice services, for example, are predominantly located in urban areas,” says Crouch.

She says that this means that rural beneficiaries, particularly those with lung or colorectal cancer, are less likely to enroll in hospice than urban beneficiaries. “If they do enroll, they often enroll much later,” says Crouch. Similarly, rural patients have less access to oncology specialists and palliative care providers.

There has been limited research focusing on the last six months of life — the costliest time — for beneficiaries with cancer, she says. “In particular, little was known about rural-urban differences in end-of-life care for cancer patients,” she adds.

Even after adjusting for sociodemographic characteristics, chronic conditions, and region, the researchers still found that rural beneficiaries had lower expenditures. “This suggests disparities in access to end-of-life care,” says Crouch. The researchers suggest that programs linking patients with the specialty care they need virtually is one approach to mitigating these disparities.

“Rural patients have a right to high-quality care at the end of life,” says Crouch.


1. Crouch E, Eberth JM, Probst JC, et al. Rural-urban differences in costs of end-of-life care for the last 6 months of life among patients with breast, lung, or colorectal cancer. J Rural Health 2018 Apr 15. doi: 10.1111/jrh.12301. [Epub ahead of print]


• Elizabeth Crouch, PhD, Assistant Professor, Department of Health Services Policy & Management, University of South Carolina, Columbia. Phone: (803) 777-0108. Email: