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High-deductible health plans linked to delayed, forgone care among cancer survivors
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Enrollment in a high-deductible health plan without a health savings account may inhibit access to care among cancer survivors and other adults, according to results of a study published in Journal of Oncology Practice.
Only one-third of individuals with a high-deductible health plan (HDHP) also have a health savings account (HSA), researchers noted.
“There is no doubt that more Americans will be covered by high-deductible health plans in the forthcoming years, for both people who are at risk for cancer as well as cancer survivors,” Zhiyuan ‘Jason’ Zheng, PhD, principal scientist in the surveillance and health services research program at American Cancer Society, told HemOnc Today. “The results [of this study] suggest that people enrolled in high-deductible plans without health savings account are at greater risk of being underinsured, and may experience difficulties to pay upfront costs for needed medical care. It is likely that this group of patients will reduce adherence to treatments or prescription medicine to save money and, in the long-run, these altered health care-seeking behaviors may lead to worse health outcomes.”
HDHPs are sometimes paired with HSAs, which are tax-exempt and can be used to help pay the high deductibles and other qualified medical expenses. Enrollment in HDHPs increased sharply between 2007 and 2017, from 4.2% to 18.9% with an HSA and from 10.6% to 24.5% without an HSA among people aged 18 to 64 years, according to study background.
Zheng and colleagues sought to examine how HDHPs and HSAs affect cancer survivorship, access to care and health care utilization in their study of 95,316 privately insured adults without a cancer history and 4,321 privately insured adult cancer survivors.
The researchers gathered data from the National Health Interview Survey and categorized the study population into six groups:
- cancer survivors with low-deductible health plans (LDHPs; n = 2,641);
- cancer survivors with HDHPs with HSAs (n = 550);
- cancer survivors with HDHPs without HSAs (n = 1,130);
- individuals with no cancer history and LDHPs (n = 62,818);
- individuals with no cancer history and HDHPs with HSAs (n = 11,366); and
- individuals with no cancer history and HDHPs without HSAs (n = 21,132).
Results showed that, among cancer survivors, having an HDHP without an HSA was associated with a higher percentage of delayed or forgone care compared with having an LDHP (13.9% vs. 7.6%; P < .001). However, the percentage of delayed or forgone care appeared similar for cancer survivors who had an HDHP with an HSA vs. those with an LDHP (8.9% vs. 7.6%).
Cancer survivors with HDHPs appeared significantly less likely to delay or forgo care if they had an HSA (P = .009).
Among individuals with no cancer history, 5.9% with an LDHP had delayed or forgone care compared with 9.5% with an HDHP and an HSA, and 10.8% with an HDHP and without an HSA (P < .001 for both). HSA enrollment appeared associated with a significantly lower percentage of delayed or forgone care among individuals who had an HDHP and no cancer history (P = .002).
The percentage of visits to the ED appeared higher among individuals with an HDHP without an HSA (15.3%), and slightly lower with an HSA (13.4%), compared with those with an LDHP (14.1%).
Use of the National Health Interview Survey, which relied on self-reported data, served as the study’s primary limitation.
“Given the increasing costs of medical care in the United States and the rapid uptake of HDHPs among those with private health insurance coverage, the opportunity to contribute to a tax-advantaged health savings account to pay for deductibles as well as other medical expenses will help patients face unexpected medical bills, especially for those with major diseases, such as cancer,” Zheng said. “Moreover, for cancer survivors, the late and lasting effects of cancer and its treatments may also increase their downstream health care needs, and a dedicated financial account for foreseeable future medical expenses will certainly improve access to care.
“We will need to understand the reasons why the majority of high-deductible enrollees do not have a health savings account, and then facilitate enrollment, especially among those who are at risk of medical financial hardship,” Zheng added. – by John DeRosier
For more information:
Zhiyuan ‘Jason’ Z heng, PhD, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303; email: jason.zheng@cancer.org.
Disclosures : Zheng reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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