High deductible insurance linked to delays in the diagnosis and treatment of cancer: shots

In 2017, Susan learned that she was carrying a genetic mutation that could put the lifetime risk of breast cancer at 72%.

His doctor explained that individuals with this BRCA2 mutation could choose a treatment. Some people opt for a double preventive mastectomy. But Susan could instead choose to have increased cancer screening, which would mean an annual mammogram and an annual MRI.

As she had just had her first child, Susan opted for increased supervision, which allowed her to maintain her ability to breastfeed.

Susan and her husband, who live in Broomall, Pennsylvania, purchase insurance from their respective employers to help pay for medical treatment. But there is a costly problem: these annual analyzes that it would require would be expensive, and their companies offered only high-deductible health care plans.

Susan's annual deductible for her plan (which covers her and her child) is $ 6,000 a year. (NPR has agreed to use only Susan's first name because she is concerned that any advertising could compromise her work.)

"I have been working at my employer for 17 years," she says. "When I started, there was no paycheck deduction for health insurance and my co-pay only cost $ 5. But in 2011, my employer went up to only offer high deductible insurance plans. "

Susan had her first mammogram and MRI in February 2017. Her cost for MRI was over $ 2,000. Her mammography bill was $ 1,088 (although she was finally able to appeal and the mammography fee was reduced to $ 191).

Due to the high bill, Susan decided to defer her annual projections from 2018 until she settled the bill payment starting in 2017.

The story of Susan who delayed care because she is underinsured is not an aberration. A study published last month in Health Affairs examined the claims data of a large national insurer regarding 316,244 women whose employers changed from low-deductible health insurance plan plans (deductibles of $ 500 or less) to plans of high deductible health care (ie, $ 1,000 or more) between 2004 and 2014.

The study group consisted of women who were on a low-deductible diet for one year and then switched to a high-deductible one-month to four-year diet. The control group consisted of women who remained in low-deductible plans.

Researchers examined the relative effects of these plans on low-income and high-income women.

Low-income women on high-deductible insurance plans waited an average of 1.6 more months for breast diagnostic imaging, 2.7 months for first biopsy, 6.6 months for first cancer diagnosis breast at an early stage and 8.7 months for the first chemotherapy, low-income women with low-deductible diets.

In some cases, delays of this length could be detrimental to health, says J. Frank Wharam, internist and insurance and population health specialist, who led the study. More research needs to be done to confirm this, he says.

Interestingly, high income women those who relied on high-deductible health care plans were not immune to such delays – they had a delay of 0.7 months for first breast imaging, 1.9 months for the first biopsy, 5.4 months for the first diagnosis of early-stage breast cancer and 5.7 months for the first chemotherapy, compared with high-income women with low-deductible diets.

Researchers also found that having a high-deductible health care system was linked to delays in care, whether women lived in metropolitan areas or not, and in predominantly white or non-white majority neighborhoods.

"In general, we find that the effects of modern high-deductible diets on access to care are sometimes predictable but often surprising," says Wharam.

"In addition to the well-known factors that can affect the speed with which a patient is diagnosed and treated – such as the level of income and the level of education – other aspects of her life are likely also playing a role. role, "he said, such as his familiarity with his sickness insurance benefits, his previous experience of interacting with an insurer, his tolerance for risk and his familiarity with the health system and his jargon.

Other recent studies have shown similar delays in the diagnosis and treatment of complications of diabetes, cardiovascular disease and other conditions. And a report from the Kaiser Family Foundation in 2017 found that 43% of adults with health insurance had difficulty meeting their deductible – up from 37% in 2015.

Dr. Veena Shankaran is Co-Director of Cancer Outcomes Research at the Hutchinson Institute at the Fred Hutchinson Cancer Research Center in Seattle, where her research focuses on the financial hardships faced by cancer patients. Although not involved in the Health Affairs study, Shankaran says the results do not surprise her.

"We're finding that high-deductible diets are really the epitome of the problem of access to care," she says. "People do not have enough cash to deal with their frankness, so you notice delays in care or even avoided treatments."

According to data from the Centers for Disease Control and Prevention, from 2007 to 2017, the number of enrollments in high-deductible health care plans related to a health savings account rose from 4.2 % to 18.9% among adults aged 18 to 64 with employment-based coverage. , while enrollments in high-deductible health care plans without HSA increased from 10.6% to 24.5% in the same age group.

Meanwhile, registrations for more traditional work plans have decreased.

The Patient Access Network Foundation, a non-profit organization based in Washington, DC, helps underinsured patients with life-threatening rare or chronic conditions to access medications and treatment by taking in charge of the costs borne by the user. Dan Klein, president and CEO of the organization, said he has seen an increase in the number of patients seeking help from PAN.

"One thing that worries me," says Klein, "is that Congress is very focused on reducing the price of prescription drugs." It's a good goal, but it does not work. makes no sense in an environment where patients still do not have access to care or medication because of their deductibles. "

Susan has resumed screenings this year. She says she has reviewed patient assistance programs, such as the one offered by Right Action for Women, which helps people at high risk of breast cancer to have access to MRI testing. But she did not meet the criteria.

In anticipation of her next exam, she set up a flexible spending arrangement at work and a health savings account that allows her to pay for at least a portion of her medical expenses with tax-free income. And she has put in place payment plans with her health care providers. Nevertheless, worries about how she and her husband will pay for the impending tests and treatment worry the couple.

"After this first MRI bill, I wanted to give up," says Susan. "Because, in addition to the BRCA diagnosis, the insurance bills were huge.

"I sometimes think of opting for surgery as a way to treat my mutation," she adds. "But then, I'm nervous – because I'm afraid of the resulting bill from the hospital."

Erika Stallings is a freelance lawyer and freelance writer based in New York. Her research focuses on disparities in health care, including breast cancer and genetics. His work appeared in HuffPost, New York Magazine, Jezebel and O, Oprah magazine. Find her on Twitter: @ quidditch424.