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High-deductible insurance plans linked to delays in breast cancer diagnosis, treatment
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Women who switched from a low-deductible to a high-deductible health care plan experienced delays in breast care diagnosis and treatment, study data showed.
“The diagnosis and treatment of breast cancer require a series of expensive services, such as diagnostic breast imaging, special visits, breast biopsy, mastectomy, lumpectomy and chemotherapy,” J. Frank Wharam, MB, BCh, BAO, associate professor of population medicine at Harvard Medical School, and colleagues wrote. “Women who face high out-of-pocket costs might delay receipt of these services.”
Researchers used the Optum insurance database to perform a controlled pre-post design study of 273,499 women aged 25 to 64 years. All women were enrolled with commercial insurance between 2003 and 2012 in a low-deductible plan ($500 or less) for 1 year, followed by as many as 4 years in a high-deductible plan ($1,000 or more) after a switch mandated by an employer.
Another 2.4 million matched women who remained in low-deductible plans served as the comparison group.
Women who switched to high-deductible plans experienced delayed receipt of diagnostic imaging (adjusted HR = 0.95; 95% CI, 0.94-0.96), as well as biopsy (HR = 0.92; 95% CI, 0.89-0.95), diagnosis of early-stage cancer (HR = 0.83; 95% CI, 0.78-0.9) and initiation of chemotherapy (HR = 0.79; 95% CI, 0.72-0.86).
During follow-up, women in the high-deductible group experienced delays in reaching a mammography rate comparable to that of the low-deductible group, as well as delays for breast biopsy, breast cancer diagnosis and chemotherapy initiation (see infographic).
“Such delays might lead to adverse long-term breast cancer outcomes,” Wharam and colleagues wrote. “Policymakers, health insurers and employers should consider designing or incentivizing health insurance benefits that facilitate transitions through key steps along the cancer care pathway.” – by Andy Polhamus
Disclosures: Wharam reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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