Administrative burdens for patients linked to cancer treatment delays, nonadherence

ByMatthew Shinkle

Fact checked byMindy Valcarcel, MS

Key takeaways:

Administrative payment burden increased risk for cost-related delays or adherence by 49%.
Some results varied by age and race.

People with cancer who engaged in administrative tasks to estimate costs or pay for care appeared considerably more likely to delay or forgo care due to costs, according to study results.

“It’s fairly unique to our U.S. health care system for the consumer to be responsible for acquiring the knowledge and skills needed to effectively use those goods or services and to ensure they’re of high quality,” Meredith Doherty, PhD, LCSW, assistant professor at University of Pennsylvania School of Social Policy and Practice, said in a press release. “In the United States, health care is largely treated as a consumer product, so the onus is on the consumer.”

stock image showing money and stethoscope — People with cancer who engaged in administrative tasks to estimate costs or pay for care appeared considerably more likely to delay or forgo care due to costs. *Image: Adobe Stock.*

Background and methodology

Patients with cancer in the United States often engage in payment-related administrative tasks, including determining the estimated costs for specific treatments or fixing billing errors.

Doherty and colleagues used data from a cross-sectional study that asked patients with cancer and cancer survivors whether they engaged in payment-related administrative tasks, and whether they delayed or decided to forgo care due to costs.

Survey respondents indicated if they never, rarely, sometimes, often or always participated in the following activities: estimated out-of-pocket costs before agreeing to a specific treatment, determining out-of-pocket costs prior to filling a prescription or undergoing a lab test/scan, asking an insurance company for help understanding coverage, or appealing a denial of benefits from an insurance company.

The survey also asked respondents if they ever postponed or skipped blood work, follow-up tests or physician appointments, delayed or skipped filling prescriptions, or skipped doses of prescribed drugs.

Results

The analysis included data from 510 survey respondents.

More than half (55%) indicated they never or rarely engaged in any administrative tasks.

Analyses adjusted for age, education, race/ethnicity and monthly out-of-pocket costs showed respondents who engaged in any administrative tasks were 18% more likely than those who did not engage in such tasks to experience any treatment delays or nonadherence.

Risk for treatment delays or nonadherence increased with engagement in each additional administrative task.

A subsequent analysis adjusted for age and estimated monthly out-of-pocket costs showed each unit increase of administrative burden — defined as engagement with additional tasks or increasing frequency of any such task — appeared associated with a 32% higher likelihood of treatment delay or nonadherence.

Multiple factors — including race/ethnicity, age and out-of-pocket costs — appeared more strongly associated with treatment delays or nonadherence than administrative burden. However, results showed African American individuals were more likely than individuals from other racial or ethnic groups to engage in administrative tasks and experience treatment delays.

Age also appeared to be a factor. Respondents aged younger than 45 years reported more payment tasks, as well as more payment tasks and cost-related delays or treatment nonadherence, than those aged older than 54 years.

Researchers acknowledged study limitations, including the use of a voluntary survey, which allowed for selective bias and recall bias. Additionally, the study did not include patients without insurance or stratify for insurance-type. The study also did not account for health literacy among survey respondents.

Next steps

Reducing the complexity of health care for people with cancer through a “human-centered design” could help reduce burdens and increase access, researchers wrote.

“For those who do engage, there’s frustration, exhaustion, and I think a sense of alienation,” Doherty said in the release. “If you send me a bill erroneously and can’t help me correct it, you’re showing me you don’t care about me. I think we’re at a place now where we may want to quantify how much improvement in outcomes we might see if we alleviated some of these administrative burdens.”