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High Out-of-Pocket Costs Lead to Delays in Breast Cancer Care for Low-Income Women

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Women with lower incomes enrolled in health insurance plans with high deductibles are more likely to delay breast cancer care, including diagnostic mammograms, biopsies, and chemotherapy, according to a study.

The research was published in the March 2019 issue of Health Affairs. Read the abstract of "Vulnerable and Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care."

How the study was done

To do the study, the researchers looked at information from 54,403 low-income and 76,776 high-income women who were enrolled in health insurance plans with a deductible of $500 or less (considered low-deductible plans) continuously for a year.

The women's employers then switched to insurance plans with a deductible of $1,000 or more (considered high deductible plans). The women were enrolled in the high-deductible plans for up to 4 years.

These women were compared to similar women who were enrolled in low deductible plans for the entire time of the study.

The researchers looked at how long it took the women to have a first breast cancer diagnostic test, a diagnosis of breast cancer, and chemotherapy treatment.

The information was collected between 2004 and 2014.

The results

Compared to low-income women in low-deductible insurance plans, low-income women in high-deductible insurance plans experienced delays across the spectrum of breast cancer care:

  • first breast imaging was delayed by 1.6 months
  • first biopsy was delayed by 2.7 months
  • a diagnosis of breast cancer was delayed by 6.6 months
  • chemotherapy treatment was delayed by 8.7 months

High-income women enrolled in high-deductible insurance plans also had delays in all the same areas of breast cancer care, though the delays were slightly shorter.

"The most likely reason that women delay these events along the path towards breast cancer diagnosis and treatment would be the barrier of high out-of-pocket costs that women face when they join high-deductible health plans," said study author J. Frank Wharam, M.D., of the Harvard Pilgrim Health Care Institute in Boston.

"What we found was that in between the stages — from screenings to diagnostic tests to a biopsy to a diagnosis of cancer to chemotherapy — there were some delays, and those delays added up to be quite substantial by the time you compared them to chemotherapy," he said.

"And again, this is likely related to fear of out-of-pocket costs," he continued. "We do know that people tend to put off care towards the end of the year when there's a high-deductible health plan because their cost sharing goes down once they hit the deductible, so that's possibly another factor."

Wharam said more research is needed to figure out if the treatment delays were linked to worse outcomes. Right now, it's not clear if delaying chemotherapy by nearly 9 months affects survival.

The researchers recommended developing policies to lower out-of-pocket costs to encourage timely breast cancer screening and treatment.

Financial help is available

If the thought of paying for breast cancer treatment and follow-up care seems overwhelming, know that resources are available to help you. Don’t panic, and don’t skip any treatments or doctor’s visits.

Many doctors keep lists of organizations that offer financial assistance for breast cancer medicines and care, as well as local organizations that offer financial assistance for practical needs such as transportation, food, and child care. Many pharmaceutical companies have set up special funds to help pay for the cost of their medicines.

For much more information and links to resources, visit Paying for Your Care.

Discuss your financial concerns with others in the Discussion Board forum Employment, Insurance, and Other Financial Issues.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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