Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access

Background: To compare healthcare expenditure, utilization and access between nonelderly adult cancer survivors enrolled in a high deductible health plan with a health savings account (“HDHP+HSA”), HDHP without HSA (“HDHP alone”) and low deductible health plan (“LDHP”). Methods: 1735 cancer survivors, aged 18–64 years, with continuous private coverage identified from the 2012–2017 Medical Expenditure Panel Survey: HDHP alone (n = 353), HDHP+HSA (n = 242) and LDHP (n = 1140). Healthcare expenditures, utilization and inability/delay obtaining medical care were analyzed using generalized linear regressions with inverse propensity score weighting and doubly robust estimation. Results: HDHP alone group (23,255 USD) had significantly higher total healthcare expenditure compared to HDHP+HSA (15,580 USD, p = 0.012) and LDHP (16,261 USD, p = 0.016). HDHP alone (6089 USD; p = 0.002) and HDHP+HSA (5743 USD; p = 0.012) groups had significantly higher out-of-pocket (OOP) expenditure compared to LDHP (4853 USD). HDHP alone (17,128 USD, p = 0.010) and LDHP (12,645 USD, p = 0.045) had significantly higher private insurer payments compared to HDHP+HSA (9216 USD). No differences were found in utilization or inability/delay obtaining medical care across groups. Conclusions: Non-elderly adult cancer survivors with continuous coverage and comparable sociodemographic characteristics enrolled in HDHP with HSA displayed the lowest healthcare costs compared to HDHP without HSA and LDHP. HDHP+HSA had a significantly higher OOP expenditure than LDHP. No significant differences were observed in utilization or access among groups.

Download Full-text

PCN210 MEDICAL CARE ACCESS AND COSTS AMONG CANCER SURVIVORS ENROLLED IN A HIGH DEDUCTIBLE HEALTH PLAN

Value in Health ◽

10.1016/j.jval.2020.04.1683 ◽

2020 ◽

Vol 23 ◽

pp. S59

Author(s):

R. Mahashabde ◽

C. Li

Keyword(s):

Cancer Survivors ◽

Medical Care ◽

Health Plan ◽

Care Access ◽

High Deductible Health Plan

Download Full-text

Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2015.62.0468 ◽

2016 ◽

Vol 34 (3) ◽

pp. 259-267 ◽

Cited By ~ 177

Author(s):

K. Robin Yabroff ◽

Emily C. Dowling ◽

Gery P. Guy ◽

Matthew P. Banegas ◽

Amy Davidoff ◽

...

Keyword(s):

United States ◽

Cancer Survivors ◽

Family Income ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Population Based ◽

Financial Hardship ◽

Medical Expenditure ◽

Logistic Regression Models ◽

Adult Cancer Survivors

Purpose To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. Methods We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one’s share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Results Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Conclusion Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.

Download Full-text

Is Health Insurance Literacy Associated With Financial Hardship Among Cancer Survivors? Findings From a National Sample in the United States

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz061 ◽

2019 ◽

Vol 3 (4) ◽

Cited By ~ 3

Author(s):

Jingxuan Zhao ◽

Xuesong Han ◽

Zhiyuan Zheng ◽

Matthew P Banegas ◽

Donatus U Ekwueme ◽

...

Keyword(s):

United States ◽

Health Insurance ◽

Cancer Survivors ◽

Medical Expenditure Panel Survey ◽

Age Groups ◽

The United States ◽

Financial Hardship ◽

Medical Expenditure ◽

Adult Cancer Survivors ◽

Health Insurance Literacy

Abstract Little is known about the association between health insurance literacy and financial hardship among cancer survivors. Using the 2016 Medical Expenditure Panel Survey Experiences with Cancer self-administered questionnaire, we evaluated the associations between health insurance literacy and medical financial hardship and nonmedical financial sacrifices among adult cancer survivors in the United States. Of the survivors, 18.9% aged 18–64 years and 14.6% aged 65 years and older reported health insurance literacy problems. In both age groups (18–64 and ≥65 years), from multivariable logistic regressions, survivors with health insurance literacy problems were more likely to report any material (adjusted odds ratio [AOR] = 3.02, 95% confidence interval [CI] = 1.53 to 5.96; AOR = 3.33, 95% CI = 1.69 to 6.57, respectively) or psychological (AOR = 5.53, 95% CI = 2.35 to 13.01; AOR = 8.79, 95% CI = 4.55 to 16.97, respectively) hardship, as well as all types of nonmedical financial sacrifices than those without these problems. Future longitudinal studies are warranted to test causality and assess whether improving health insurance literacy can mitigate financial hardship.

Download Full-text

Appropriateness of cardiovascular care in elderly adult cancer survivors

Medical Oncology ◽

10.1007/s12032-013-0561-4 ◽

2013 ◽

Vol 30 (2) ◽

Cited By ~ 7

Author(s):

Winson Y. Cheung ◽

Raisa Levin ◽

Soko Setoguchi

Keyword(s):

Cancer Survivors ◽

Elderly Adult ◽

Adult Cancer Survivors ◽

Cardiovascular Care

Download Full-text

Association of patient-reported experiences with health resource utilization and cost among US adult population, medical expenditure panel survey (MEPS), 2010–13

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy217 ◽

2018 ◽

Vol 31 (7) ◽

pp. 547-555 ◽

Cited By ~ 1

Author(s):

Khurram Nasir ◽

Victor Okunrintemi

Keyword(s):

Healthcare Expenditure ◽

Medical Expenditure Panel Survey ◽

Patient Experiences ◽

Medical Expenditure ◽

Shared Decision ◽

Health Resource ◽

Panel Survey ◽

Health Resource Utilization ◽

Healthcare Experience ◽

Study Population

Abstract Objectives To determine whether optimal patient experiences with healthcare is associated with enhanced and efficient use of healthcare resources and cost. Design Retrospective cohort study. Setting and participants The study population consisted of pooled participants from the 2010–13 Medical Expenditure Panel Survey cohort of adults ≥18 years with a regular healthcare provider and ≥1 visit to a healthcare provider within the survey year. Using a self-administered questionnaire, individual responses to questions related to healthcare experience were used to develop a weighted average for each of these patient-centered care matrices (ease of access to healthcare, patient–provider communication, shared decision-making and overall patient satisfaction). Intervention None. Outcome measures The outcomes of interest included (1) emergency room (ER) visits and hospital stay, (2) annual healthcare costs incurred by the respondents. Results Overall the study population consisted of 47 969 individuals ≥18 years representing nearly 130 million US non-institutionalized adults. Compared with individuals with a poor report on healthcare experience, participants with positive reports were less likely to utilize the ER and had a lower annual healthcare expenditure. This relationship between patient experience and healthcare expenditure was not demonstrated with shared decision-making and overall patient satisfaction. Conclusion Our study findings suggest that there is an association between patient experience with healthcare, health resource utilization and healthcare expenditure. Further studies are needed to assess if interventions focused to enhance patient experiences can improve healthcare efficiency.

Download Full-text

Younger survivors' insurance concerns.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.277 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 277-277

Author(s):

Ruth Rechis ◽

Stephanie Nutt ◽

Carla Bann ◽

Linda Squiers

Keyword(s):

Cancer Survivors ◽

Help Seeking ◽

Online Survey ◽

Medical Expenditure Panel Survey ◽

Insurance Coverage ◽

Family Members ◽

Medical Expenditure ◽

Negative Effects ◽

Seeking Help ◽

To Receive

277 Background: Each year approximately 70,000 adolescents and young adults (AYAs) are diagnosed with cancer—many of whom will experience insurance issues. While the Affordable Care Act (ACA) is intended to address many insurance issues, cancer survivors are dealing with these issues now. Methods: From June to December 2012, LIVESTRONG conducted an online survey modeled after the Medical Expenditure Panel Survey (MEPS) Cancer Survivorship Supplement to understand the practical concerns of survivors, including insurance issues. Analyses here includes 1,209 AYA respondents compared to 3,557 respondents diagnosed over the age 40. Results: Overwhelmingly, participants in this survey had insurance at some point since diagnosis (94%), yet AYAs were significantly less likely to have had insurance (p<.001). AYAs were significantly more likely to have experienced issues with insurance (Table), but both groups were unlikely to have received help for negative effects due to insurance (AYA = 30%; non-AYAs=25%). In terms of help seeking, AYAs were significantly more likely to have received help from family members (p<.001). Both groups indicated a number of reasons for not seeking help for insurance issues - most frequently citing "I have addressed this on my own” (18%) and “I tried to receive help but was unsuccessful” (17%). Conclusions: Results from this study indicate there are many issues related to insurance coverage for survivors, which in most cases were significantly more impactful for AYA survivors. Additionally, there are many challenges survivors face in terms of getting their insurance needs met. Finally, it’s important to consider the full implications of what it means for AYAs to be reliant on family members – for both the survivor and their family. The AYA period often denotes a time that individuals are trying to separate from family, yet cancer may make this separation considerably more challenging. While ACA is intended to address some of these issues, cancer survivors are dealing with insurance issues now, and we should consider how to address these issues more quickly. [Table: see text]

Download Full-text

Long-term cancer survivors: Satisfaction with medical care and information received during the diagnosis and treatment of cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21573 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21573-e21573

Author(s):

Alejandro Gallego ◽

Beatriz Martinez ◽

Enrique Espinosa ◽

Ismael Ghanem ◽

Leticia Ruiz-Gimenez ◽

...

Keyword(s):

Cancer Survivors ◽

Medical Care ◽

Family Doctor ◽

Daily Intake ◽

Diagnosis And Treatment ◽

Depression Symptoms ◽

Term Survival ◽

Family Doctors ◽

Adult Cancer Survivors

e21573 Background: Long-term survival rates for many types of cancer have substantially improved in past decades. A specific medical office was started up two years ago at our institution for the follow-up and comprehensive care of this population. Long-term cancer survivors were surveyed to know how they perceive medical care and information received during the diagnosis and treatment of cancer. Methods: A 54-item questionnaire was developed based on QLACS (Quality of Life in Adult Cancer Survivors). 286 patients completed the questionnaire from January 2015 to December 2016. All of them were disease-free and without any antitumour therapy for at least two years. The information was collected in a database and processed with SPSS 18. Results: Median age at the time of diagnosis was 56 years. Colorectal and breast carcinomas accounted for 54% of all cases and 61% of patients had been diagnosed in early stages of disease. Median time from cancer diagnosis to questionnaire completion was 104 months (range 29-444 months). Sixty-seven per cent of patients were satisfied with the information received by their oncologist about their cancer, although information provided about other health issues was less satisfactory. Twenty-eight per cent reported that the oncologist never made recommendations about healthy lifestyle. In fact, only 8 patients (2.8%) made dietary modifications, all regular alcohol drinkers (31.1%) maintained their daily intake and 73 patients (25.5%) gained 5 kg over their recommended weight. Anxiety/depression symptoms were reported by 30% of the best informed patients about cancer treatment and 52% of the worst informed. Only 12.4% of long-term cancer survivors of our study consulted their family doctor during the last year, while 75.4% visited their oncologist. Finally, the medical care of the oncologist was satisfactory for 235 patients (83.2%), receiving an overall score of 8.7 on a 0 to 10 scale. Conclusions: Most long-term cancer survivors feel satisfied with the medical care received, but the information provided about other health aspects should be improved. Furthermore, although they rely on their family doctors, most prefer being followed-up by their oncologist.

Download Full-text