Delivery of Financial Navigation Services within National Cancer Institute-Designated Cancer Centers

Abstract Background Cancer Centers have a responsibility to help patients manage the costs of their cancer treatment. This article describes the availability of financial navigation services within the National Cancer Institute (NCI)-Designated Cancer Centers. Methods Data were obtained from the NCI Survey of Financial Navigation Services and Research, an online survey administered to NCI-Designated Cancer Centers from July to September 2019. Of the 62 eligible Centers, 57 completed all or most of the survey, for a response rate of 90.5%. Results Nearly all Cancer Centers reported providing help with applications for pharmaceutical assistance programs and medical discounts (96.5%), health insurance coverage (91.2%), assistance with non-medical costs (96.5%), and help understanding medical bills and out-of-pocket costs (85.9%). Although other services were common, in some cases they were only available to certain patients. These services included direct financial assistance with medical and non-medical costs and referrals to outside organizations for financial assistance. The least common services included medical debt management (63.2%), detailed discussions about the cost of treatment (54.4%), and guidance about legal protections (50.1%). Providing treatment cost transparency to patients was reported as a common challenge: 71.9% of Centers agreed or strongly agreed that it is difficult to determine how much a cancer patient’s treatment will cost and 70.2% of oncologists are reluctant to discuss financial issues with patients. Conclusions Cancer Centers provide many financial services and resources. However, there remains a need to build additional capacity to deliver comprehensive financial navigation services and to understand the extent to which patients are referred and helped by these services.

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Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200966 ◽

2021 ◽

pp. bmjsrh-2020-200966

Author(s):

Heidi Moseson ◽

Laura Fix ◽

Caitlin Gerdts ◽

Sachiko Ragosta ◽

Jen Hastings ◽

...

Keyword(s):

United States ◽

Clinical Supervision ◽

Online Survey ◽

Clinical Care ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

The United States ◽

Physical Trauma ◽

Abortion Care ◽

And Gender

BackgroundTransgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.MethodsIn 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.ResultsOf 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.ConclusionsThese data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

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Immigration Relief and Insurance Coverage: Evidence from Deferred Action for Childhood Arrivals

The B E Journal of Economic Analysis & Policy ◽

10.1515/bejeap-2019-0305 ◽

2020 ◽

Vol 20 (3) ◽

Author(s):

Jung Bae

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Financial Assistance ◽

Eligibility Criteria ◽

Deferred Action ◽

Percentage Points ◽

Health Institutions ◽

Medical Financial Assistance ◽

The U.S

AbstractI find that the 2012 Deferred Action for Childhood Arrivals (DACA) program, which conferred protection from deportation and work authorization to undocumented immigrants who had been brought to the U.S. as children, increased eligible immigrants’ likelihood of having health insurance coverage. Exploiting a cutoff rule in the eligibility criteria of DACA, I implement a difference-in-regression-discontinuities design. The insured rate increased by up to 4.3 percentage points more for DACA-eligible immigrants than for ineligible immigrants following DACA. Two-thirds of this increase is accounted for by upticks in employer-sponsored and privately purchased insurance. The findings are also consistent with immigrants becoming less averse to approach health institutions, and taking up medical financial assistance at a higher rate.

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Financial burden experienced by patients undergoing treatment for malignant gliomas

Neuro-Oncology Practice ◽

10.1093/nop/npu002 ◽

2014 ◽

Vol 1 (2) ◽

pp. 71-76 ◽

Cited By ~ 3

Author(s):

Priya Kumthekar ◽

Becky V. Stell ◽

Daniel I. Jacobs ◽

Irene B. Helenowski ◽

Alfred W. Rademaker ◽

...

Keyword(s):

Financial Support ◽

Tumor Recurrence ◽

Financial Burden ◽

Insurance Coverage ◽

Malignant Gliomas ◽

Indirect Costs ◽

Medical Costs ◽

Health Insurance Coverage ◽

Preferred Provider Organizations ◽

Hospital Bill

Abstract Background Patients undergoing treatment for malignant gliomas (MGs) can encounter medical costs beyond what their insurance covers. The magnitude and type of costs experienced by patients are unknown. The purpose of this study was to have patients or their families report on the medical costs incurred during the patients MG treatment. Methods Patients with MG were eligible if they were within 6 months of diagnosis or tumor recurrence. Patients had to be ≥18 years of age, fluent in English, and not aphasic. Weekly logbooks were issued to patients for recording associated costs for ∼6 months or until tumor progression. “Out-of-pocket” (OOP) costs included medical and nonmedical expenses that were not reimbursed by insurance. Direct medical costs included hospital and physician bills. Direct nonmedical costs included transportation, parking, and other related items. Indirect medical costs included lost wages. Costs were analyzed to provide mean and medians with range of expenses. Results Forty-three patients provided cost data for a median of 12 weeks. There were 25 men and 18 women with a median age of 57 years (range, 24y–73y); 79% were married, and 49% reported annual income >$75 000. Health insurance coverage was preferred provider organizations for 58% of patients, and median deductible was $1 500. Median monthly OOP cost was $1 342 (mean, $2 451; range, $333.41–$17 267.16). The highest OOP median costs were medication copayments ($710; range, $0–13 611.20), transportation ($327; range, $0–$1 927), and hospital bill copayments ($403; range, $0–$4 000). Median lost wages were $7 500, and median lost days of work were 12.8. Conclusions OOP costs for MG patients can be significant and comprise direct and indirect costs across several areas. Informing patients about expected costs could limit additional duress and allow financial support systems to be implemented.

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Financial Well-Being of the Non-Profit Social Service Workforce in China

The British Journal of Social Work ◽

10.1093/bjsw/bcaa176 ◽

2020 ◽

Author(s):

Ling Zhou ◽

Baorong Guo ◽

Jin Huang

Keyword(s):

Social Service ◽

Financial Services ◽

Online Survey ◽

Insurance Coverage ◽

Secondary Data ◽

Well Being ◽

Individual Characteristics ◽

Urban China ◽

Service Employees ◽

Non Profit

Abstract Using secondary data from the 2017 online survey of 736 non-profit social service employees in urban China, this study provides a complete description of the financial well-being of the non-profit social service workforce and examines correlates of financial well-being. Results show that non-profit employees’ household income is lower than the disposable income of a typical urban household. Nearly one-third of social service professionals have short-term unsecured debts, 10 per cent do not have public health insurance coverage and another 22 per cent report economic hardships caused by large unexpected expenses. Correlates of financial well-being include individual characteristics (e.g. age, education and marital status) and organizational characteristics (type, revenue and size). New services (e.g. employment-based programmes and financial services) are proposed to promote financial well-being of non-profit social service employees in China.

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Challenges with insurance and finances: Results from the 2012 Livestrong survey.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.208 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 208-208

Author(s):

Stephanie Nutt ◽

Carla Bann ◽

Sarah R. Arvey ◽

Linda Squiers ◽

Ruth Rechis

Keyword(s):

Health Insurance ◽

Cancer Survivors ◽

Online Survey ◽

Financial Burden ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Financial Resources ◽

Insurance Company ◽

Related Factors ◽

The U.S

208 Background: More than 1.5 million new cancer cases occur each year in the U.S., and accessing health care is critical for mortality as well as for improving survivorship outcomes for cancer survivors. Methods: LIVESTRONG conducted an online survey of cancer survivors from June to December 2012. The current analyses include 4,320 respondents who were U.S. residents and diagnosed in 2002 or later. Results: Survivors in this study reported that for those who did not receive all of the medical care they needed they did not receive care because the insurance company wouldn’t pay for the care (41%) or they couldn’t afford the care (23%), with nine percent being denied health insurance coverage due to a cancer diagnosis. Other challenges reported included insurance not paying for a second opinion (8%) or the doctor/facility of the survivor’s choice (18%). Controlling for demographic and cancer-related factors, those diagnosed most recently (2010-2012) were less likely to report experiencing these challenges. Compounding insurance issues was the financial burden. Thirty percent of survivors reported that they or their family members had to borrow money or go into debt because of their cancer and five percent of survivors reported spending down their assets to qualify for Medicaid or a cancer-related program. Conclusions: In previous studies, patients who lack sufficient health insurance coverage tend to have poorer health outcomes. Overall, the data highlights that more can be done to connect survivors with the needed insurance and financial resources they need to access adequate cancer care during their treatment and beyond. [Table: see text]

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