1560 Background: Rising costs of cancer care have imposed substantial financial burden on cancer survivors. To date, little is known about the associations between potentially modifiable patient characteristics, including health insurance literacy (HIL), on financial burden among cancer survivors. This study aimed to evaluate the associations between HIL and financial hardship and financial sacrifices among adult cancer survivors in the United States. Methods: We identified 914 adult cancer survivors from the 2016 Medical Expenditure Panel Survey Experiences with Cancer Questionnaire. HIL was measured based on the question “Did you ever have a problem understanding health insurance or medical bills related to your cancer, its treatment, or the lasting effects of that treatment?” Medical financial hardship was measured in three domains—1) material (e.g. problems paying medical bills); 2) psychological (e.g. worry about large medical bills); and 3) behavioral (e.g. delay or forego healthcare because of cost). Financial sacrifices were based on questions related to changes in spending on vacation or leisure activities. We used multivariable logistic regression modeling to separately evaluate the associations between HIL problems and 1) financial hardship and 2) financial sacrifices. Results: 18.9% cancer survivors aged 18-64 years and 14.6% survivors ≥65 years reported HIL problems. Regardless of age groups, cancer survivors with HIL problems were more likely to report any material (OR =3.2; 95% CI:1.9-5.2) or psychological (OR=7.2; 95% CI: 4.1-12.7) financial hardship than those without the problems, as well as more likely to delay or forgo multiple medical care due to cost, including prescription medicine (OR=3.6; 95% CI: 1.8-7.1), specialist visit (OR=2.6; 95% CI: 1.2-5.8), and follow-up care (OR=2.1, 95% CI 1.2-4.0). Higher likelihood of reporting all measures of financial sacrifices were observed among those with HIL problems in both age groups (all p<0.05). Conclusions: Cancer survivors with HIL problems were more likely to report financial hardship and financial sacrifices than those without the problems. Improving HIL may help mitigate financial hardship.
FINANCIAL HARDSHIP FROM MEDICAL BILLS AMONG PATIENTS WITH HEART FAILURE IN THE UNITED STATES