High-deductible health plans increase cancer survivors’ risk of subsequent death
High-deductible health plans appear to increase cancer survivors’ risk of subsequent death, likely due to forgoing medical imaging and other necessary follow-up care, according to new research.
The popularity of such plans—which offer lower premiums at the expense of higher deductibles and out-of-pocket costs—has grown in recent years as healthcare stakeholders seek to cut costs. Previous research has shown high-deductible health plans can decrease utilization, but it’s unclear whether they impact cancer outcomes, experts detailed in JAMA Network Open.
Radiation oncologists recently aimed to answer this question, using data from the National Health Interview Survey. They found that high-deductible plans were associated with worse mortality rates for cancer survivors, possibly due to patients being discouraged from receiving necessary medical care.
“Prior research has demonstrated that women with breast cancer enrolled in HDHPs are more likely to experience delays in imaging, biopsy and diagnosis, which have downstream implications on timely initiation of treatment,” Justin M. Barnes, MD, MS, a radiation oncologist with the Mayo Clinic, Rochester, Minnesota, and co-authors wrote Jan. 29. “Our findings add to the literature by demonstrating the negative associations for cancer survivors for downstream outcomes like survival, which seems to be in part mediated by the financial strain associated with HDHPs,” they added later.
The study included individuals ages 18 to 84 with insurance other than Medicaid, who were surveyed by the CDC sometime between 2011 and 2018. The final sample included over 147,000 respondents at an average age of 46. Among them were over 2,300 cancer survivors (26%) and 37,000 individuals (29%) without a history of the disease, all of whom had a high-deductible health plan at the time of the survey.
HDHP status was associated with worse overall and cancer-specific survival among those who had the disease previously, the study found. This was not the case among other adults without a history of cancer. Further analysis showed that HDHP status among cancer survivors was related to increased financial barriers to care, which appeared to directly impact survival outcomes.
“Contributing factors to the association of HDHPs with survival likely included financial toxic effects and delaying or forgoing necessary medical care due to costs,” the authors concluded. “In the current political environment … these results suggest that HDHP proliferation could exacerbate adverse cancer outcomes. These data underscore the importance of educating patients with cancer about potential (increased) need for healthcare utilization, educating the public about potential risks of HDHPs, identifying policy solutions to decrease costs of care, and optimizing health policies to avoid disincentives for seeking what may turn out to be necessary and lifesaving or life-prolonging care,” they added.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.