24 Jun High-Deductible Health Plans Increase Disparities in Access to Care Among Cancer Survivors
MedicalResearch.com Interview with:
Megan B. Cole Brahim, PhD, MPH
Assistant Professor | Dept. of Health Law, Policy, & Management
Boston University School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Enrollment in high deductible health plans (HDHPs)—which require patients to pay on the upwards of thousands of dollars in out-of-pocket costs before they can use their health insurance coverage for most services—has skyrocketed over the last decade. For cancer survivors in particular, this is really concerning, as patients may avoid or delay necessary health care services or important medications because they can’t afford their deductible. We know from previous work that HDHPs are associated with less use of health care, including less cancer screening and treatment. However, there has been very little work to assess how HDHPs may contribute to racial/ethnic disparities in care, and our study is the first known study to assess how HDHPs may contribute to racial/ethnic disparities in cancer survivors.
To fill this gap, we used nationally representative survey data from 2013-2018 to assess how enrollment in high deductible health plans was associated with cost-related barriers to care among cancer survivors with private insurance, and how this relationship varied across racial/ethnic groups.
MedicalResearch.com: What are the main findings?
Response: Among privately insured cancer survivors, enrollment in high deductible health plans increased from 37% in 2013 to 50% in 2018. Enrollment in HDHPs was associated with greater cost-related barriers to care when comparing cancer survivors with vs. without a HDHP, after statistically balancing on and adjusting for observable patient-level sociodemographic and clinical factors; notably, this negative association was significantly greater for Black vs. non-Hispanic White cancer survivors for 4 of the 8 measures that we examined (p<0.05). For instance, 22.8% of Black vs. 8.0% of White cancer survivors with a HDHP plan skipped medication to save money, compared to 7.7% of Black vs. 5.4% of White cancer survivors without a HDHP. Similarly, HDHPs were associated with significantly more Black cancer survivors taking less medication to save money, delaying filling a prescription to save money, and not being able to afford a specialist, as compared to their non-Hispanic White counterparts (p<0.05).
MedicalResearch.com: What should readers take away from your report?
Response: As the first known study to demonstrate that high deductible health plans may contribute to significant racial/ethnic disparities in access, we found HDHPs were associated with cost-related barriers to care for cancer survivors, and these barriers were substantially greater for Black patients with HDHPs. As enrollment in HDHPs continues to rise, this has really concerning implications for racial equity among cancer survivors. Enrollment in HDHPs may compound the racism and many structural inequities that Black cancer survivors are already facing, which may further drive disparities in health outcomes for survivors.
Policies that limit deductible sizes or eliminate cost sharing to high-risk groups may help to mitigate observed effects. But more broadly, we need policies that really tackle structural racism and inequities that lie at the root of these disparities.
MedicalResearch.com: Is there anything else you would like to add?
Response: It’s also important to think about these results in the context of COVID-19—where many Americans, especially Black Americans, have lost their jobs or have had their hours or wages cut. For those who have been able to maintain their private health insurance coverage or who have otherwise obtained coverage via the Marketplace, a high percentage of those individuals may be enrolled in HDHPs. With less income coming in, the harmful effects of HDHPs may be more pronounced than ever—further widening the racial equities that we already see.
Cole MB, Ellison JE, Trivedi AN. Association Between High-Deductible Health Plans and Disparities in Access to Care Among Cancer Survivors. JAMA Netw Open. 2020;3(6):e208965. doi:10.1001/jamanetworkopen.2020.8965
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