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Financial Burden an Unintended Outcome of Cancer Care

Surabhi Dangi-Garimella, PhD
K. Robin Yabroff, PhD, strategic director, Surveillance and Health Services Research Program, American Cancer Society, would like to see more longitudinal studies that can develop more informed policies to alleviate patient financial hardship. Yabroff was speaking at the Cost-Sharing Roundtable co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®
Financial hardship, a common phenomenon among working-age patients, can have different aspects: material, psychological, or behavioral, according to K. Robin Yabroff, PhD, strategic director, Surveillance and Health Services Research Program, American Cancer Society. Yabroff was presenting at the Cost-Sharing Roundtable co-hosted by the Patient Access Network (PAN) Foundation and The American Journal of Managed Care® on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC.

Yabaroff told the audience that results from their yet unpublished studies among patients with cancer history identified compelling evidence of financial stress, “with patients telling us about credit card debt accrued as a result of time away from work” as well as losing their home and filing for bankruptcy—all consequences of patients' savings being wiped out following severe illness. Meeting the costs associated with their chronic disease condition was a considerable stressor for patients, over and above the stress associated with their diagnosis and associated treatment. Some patients also indicated that they had compromised their career by staying locked in a job that offered good insurance coverage.

According to a 2012 update, nearly 50% of US adults were living with at least 1 chronic condition and about 25% had at least 2 chronic conditions.1 The growing healthcare expenditures can increase out-of-pocket (OOP) spending, and growing OOP costs can indirectly affect outcomes if patients delay seeking care or, worse, forego their care, Yabroff noted.

Financial hardship among patients in the United States is affected by several different factors, including:
  • Prevelance of high-deductible health plans (HDHPs)
  • Growing patient cost sharing through higher deductibles, co-pays, and coinsurance
  • Changing treatment patterns
  • Rising cost of treatment
  • A growth in the number of uninsured individuals.

Studies have indicated that a significantly higher number of individuals signed up for an HDHP in 2017, Yabroff said. HDHPs have a higher deductible than a traditional health plan and can be combined with a health savings account, which allows payment of medical expenses with tax-free money. According to the National Health Interview Survey, HDHP enrollment increased by nearly 4 percentage points in the first 9 months of 2017 (43.2%, up from 39.4% in 2016).2

Results gathered from the 2015-2016 National Health Interview Survey found that a significant proportion (45.2%) of individuals between ages 18 and 64 years who were worried about paying their medical bills were uninsured; nearly 19% had public insurance and about 10% had private insurance. The population aged 65 years and older saw a much smaller stress of medical bills, however: 8.9% of those with Medicare only, 6.9% with Medicare and public insurance, and 3.2% with Medicare and private insurance faced financial hardship with their treatment.

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