It has been well-documented that the type of health insurance can impact patients’ decisions about seeking care, thereby potentially affecting health outcomes. A new study published in JAMA Oncology by Frank Wharam, Duke Professor of Medicine, and colleagues has confirmed that shifts to high-deductible health plans (HDHP) are associated with reduced visits to non-oncologists among cancer patients. In addition, and not surprisingly, their out-of-pocket medical expenses increased substantially. These findings were based on an analysis of data from more than 45,000 cancer patients and matched individuals between 2003-2017 from Optum Clinformatics Data Mart database. HDHPs were defined as employer-mandated benefits that had an annual deductible of $1000 or more.
In recent years, the prevalence of HDHPs has been increasing with no signs of abatement. A 2021 study by ValuePenguin reported that more than half of Americans employed in the private sector (56%) were enrolled in HDHPs.
The study by Wharam and colleagues found that out-of-pocket costs in the HDHP group increased by $1,350 from baseline to follow-up relative to control group members, and averaged more than $3,000 per patient annually during HDHP enrollment. These new findings align with a 2022 report of higher out-of-pocket costs for multiple myeloma treatment for HDHP patients. Higher out-of-pocket expenses for HDHP versus traditional plan enrollees has also been reported for other chronic diseases such as diabetes.
In addition, the Wharam study found that HDHP patients had almost 11% fewer outpatient visits to primary care physicians and 6% fewer visits to non-cancer specialists than the control group. The reduction in comprehensive care for these patients could result in suboptimal management of acute health complaints, preventive care, and chronic illnesses such as hypertension, diabetes, and depression.
“Cancer patients face a multitude of stressful complexities related to their disease,” commented Wharam, “including major medical expenses. Some patients appear to be forgoing non-cancer care to save money, which could have negative effects on both their overall health and their cancer treatment.”
Sources:
Trad NK, Zhang F, Wharam FJ. Out-of-pocket costs and outpatient visits among patients with cancer in high deductible health plans. JAMA Oncol. Published online January 18, 2024. doi:10.1001/jamaoncol.2023.6052. PMID: 38236593
DeMarco J. Rate of Workers Enrolled in High-Deductible Health Plans Jumps for 8th Year in Row to Record 55.7%. January 30, 2023. Available at https://www.valuepenguin.com/high-deductible-health-plan-study#Methodol…
Jazowski et al. Association of High-Deductible Health Plan Enrollment With Spending on and Use of Lenalidomide Therapy Among Commercially Insured Patients With Multiple Myeloma. JAMA Netw Open. 2022 Jun 1;5(6):e2215720. doi: 10.1001/jamanetworkopen.2022.15720. PMCID: PMC9175078.
Garabedian et al. Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study. BMJ Open. 2021; 11(9): e044198. PMID: 34518242