High-deductible health plans erect ‘barriers’ to comprehensive care for cancer survivors
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Key takeaways:
- High-deductible health-care plans cost patients substantially more in annual out-of-pocket costs than low-deductible plans.
- Individuals enrolled in high-deductible plans visit primary care physicians less.
Patients with cancer enrolled in high-deductible health-care plans paid, on average, nearly 70% more in out-of-pocket medical expenses annually than those in low-deductible plans, according to a study in JAMA Oncology.
Oncology visits did not statistically differ between the two groups, but patients in high-deductible health-care plans (HDHP) made fewer visits to primary care physicians and noncancer specialists.
“Cancer survivors face unique and lifelong health challenges related to cancer and its treatment,” Nicolas K. Trad, MD, clinical fellow at Massachusetts General Hospital, and colleagues wrote. “Potential reductions in PCP and noncancer specialist visits observed in this study suggest that cancer survivors enrolled in HDHPs may face barriers in accessing comprehensive care.”
Background and methodology
Enrollment in HDHPs increased the past 2 decades, causing patients with cancer and their families to pay more money out of pocket for their care, according to background information provided by the researchers.
Cancer care can be wide-ranging and require expansive follow-ups, and extra costs could limit which patients receive necessary treatments.
Trad and colleagues evaluated data from January 2003 to July 2017 in the deidentified Optum Clinformatics Data Mart database to construct their research population.
The HDHP cohort consisted of patients required to switch out of low-deductible plans, while the control group had patients who maintained their low deductibles. The analysis included patients aged between 18 and 64 years.
Results
Researchers matched the HDHP cohort of 2,703 patients with a control group of the same size to create nearly identical groups demographically (mean age, 52.9 years; 58.5% women; 69.3% white) and based on cancer type.
Patients in HDHPs had costs go up 68.1% (95% CI, 51-85.3) annually, with an average “absolute increase” of out-of-pocket medical expenses of $1,349.80 (95% CI, $1,060.30-$1,639.20).
Patients in HDHPs had similar follow-up costs vs. baseline costs ($3,330.90 vs. $3,670.00), but the control group had much lower follow-up expenses compared with baseline ($2,075.50 vs. $3,844.90).
Patients in HDHPs visited primary care physicians 10.8% less than the control group (95% CI, 15.5 to 5.9) and went to noncancer specialists 5.9% less (95% CI, 11.2 to 0.3).
“In previous research, survivors of colorectal cancer who saw both a PCP and an oncologist were more likely to receive necessary care across a broad set of indicators compared with those who saw only oncologists,” researchers wrote. “Similarly, nononcology specialists play an important role in addressing psychosocial needs and the late effects of cancer and its treatments, including cognitive dysfunction, infertility and cardiomyopathy.
“Future studies should examine the association of HDHPs with health-related quality of life in cancer survivors,” they added.
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