Association of cancer history and medical financial hardship with mortality in the United States.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 86-86
Author(s):  
K Robin Yabroff ◽  
Xuesong Han ◽  
Weishan Song ◽  
Jingxuan Zhao ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Mortality Risk ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Financial Hardship ◽  
Cancer History ◽  
Risk Of Mortality

86 Background: Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about its long-term health consequences. In this study, we examine the associations of cancer history, medical financial hardship and mortality in a large nationally representative sample. Methods: We identified cohorts of adults aged 18-64 years (n = 415,114) and 65-79 years (n = 73,571) from the 1997-2014 National Health Interview Survey (NHIS) and the NHIS Linked Mortality Files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any medical care due to cost in the past 12 months using survey questions consistently available in all NHIS years. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, controlling for the effects of sex, race/ethnicity, educational attainment, marital status, comorbid conditions, region, and survey year. Health insurance coverage was added separately to multivariable models. All estimates accounted for the complex survey design. Results: Among adults aged 18-64 years, 29.6% with and 21.3% without a cancer history reported financial hardship Among adults aged 65-79 years with and without a cancer history, the same percentage reported financial hardship: 11.1%. Among adults aged 18-64 years, cancer survivors with financial hardship had the highest adjusted mortality risk (hazard ratio [HR]: 2.14, 95% confidence interval [95CI]: 1.92-2.37); followed by cancer survivors without medical financial hardship (HR: 1.93, 95CI: 1.81-2.06); and adults without a cancer history with medical financial hardship (HR: 1.36; 95CI: 1.31-1.41) compared with adults with neither a cancer history nor financial hardship. Similar pattern was observed among adults aged 65-79 years: cancer survivors with (HR: 1.62, 95CI: 1.45-1.82) and without (HR: 1.34, 95CI: 1.28-1.24) medical financial hardship and adults without a cancer history with financial hardship (HR: 1.17, 95CI: 1.10-1.24) had elevated mortality risk. Further adjustment for health insurance coverage reduced the magnitude of association of financial hardship and mortality among adults 18-64 years, but further adjustment for insurance had little effect on mortality risk among those aged 65-79 years. Conclusions: Medical financial hardship was associated with increased risk of mortality among adults with and without a cancer history, highlighting the need for efforts to mitigate financial hardship in the United States.

Health Insurance Coverage Disruptions and Access to Care and Affordability among Cancer Survivors in the United States

2020 ◽  
Vol 29 (11) ◽  
pp. 2134-2140
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Leticia Nogueira ◽  
Zhiyuan Zheng ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Access To Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States

Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 68-68
Author(s):  
Jingxuan Zhao ◽  
Zhiyuan Zheng ◽  
Xuesong Han ◽  
Amy J. Davidoff ◽  
Matthew P. Banegas ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Survivors ◽  
Coping Strategies ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Care Providers ◽  
Cancer History

68 Background: Policy makers, health care providers and patients are increasingly concerned about rising costs for prescription drugs and cost-related medication non-adherence (CRN). This study aims to evaluate the relationship between cancer history and CRN as well as cost-coping strategies, by health insurance coverage. Methods: We used the National Health Interview Survey data from 2013-2016 to identify adults age 18-64 with (n = 3 599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included a) CRN (skipping, taking less or delaying medication because of cost), and b) cost-coping strategies (requesting lower cost medication or using alternative therapies to save money). Separate multivariable logistic regressions were used to calculate the adjusted percentages of CRN and cost-coping strategies associated with cancer history, stratified by health insurance. Results: Cancer survivors reported higher percentages of CRN (14.5% vs. 12.1%, P < .001) and were slightly more likely to report using cost-coping strategies (24.4% vs. 22.8%, P = .060) compared with adults without a cancer history. The magnitude of differences in CRN by cancer history varied by insurance type (any private 10.2% vs. 8.6%, P = .034; public only 17.9% vs. 14.2%, P = .010; uninsured 41.0% vs. 33.2%, P = .064). Among the privately insured, the difference in CRN by cancer history was greatest among those enrolled in high deductible health plans (HDHP) without health saving accounts (HSA) (16.9% vs. 10.9%, P = .002). Regardless of cancer history, CRN and use of cost-coping strategies were highest for those uninsured, enrolled in HDHP and without HSA, and without prescription drugs coverage under their health plan (all P < .001). Conclusions: Cancer survivors are prone to CRN and more likely to use cost-coping strategies to minimize financial hardship. Expanding options for health insurance coverage and use of HSA, and prescription drug coverage may be effective strategies to address CRN.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

scholarly journals Union Effects on Health Insurance Provision and Coverage in the United States

ILR Review ◽  
2002 ◽  
Vol 55 (4) ◽  
pp. 610-627 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
John Dinardo ◽  
Robert G. Valletta
Keyword(s):  
United States ◽  
Health Insurance ◽  
Survey Data ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Union Density ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Coverage ◽  
Private Sector Union

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983–97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee “take-up” of offered insurance, and that declining unionization explains 20–35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

Health insurance literacy, financial hardship and financial sacrifices among cancer survivors in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1560-1560
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Zhiyuan Zheng ◽  
Matthew P. Banegas ◽  
Donatus U. Ekwueme ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Financial Burden ◽  
Age Groups ◽  
The United States ◽  
Financial Hardship ◽  
Adult Cancer Survivors ◽  
Health Insurance Literacy ◽  
Medical Bills

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.

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