- Patients who are not prepared for the magnitude of their out-of-pocket costs for cancer care are more likely to be distressed and less likely to pay their bills than other individuals, according to a research letter published in JAMA Oncology.
Thirty-nine percent of participants in a Duke University survey reported higher-than-expected costs for their cancer care, which indicates a significant opportunity for payers to provide more education and greater transparency around the costs associated with treatment.
"Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden,” the team said. “This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision making. Interventions to improve patient health care cost literacy might impact decision making."
Underinsured patients are a growing concern for payers and providers, the researchers said, and the problem may increase as federal lawmakers consider changes to the Affordable Care Act. Premiums are increasing due to market uncertainty and high-deductible plans are becoming a popular way to keep monthly costs low for beneficiaries. But when a major disease like cancer requires care, those large out-of-pocket expenses could lead to difficult decisions for financially insecure patients.
“Owing to cost sharing, even insured patients face financial burden and are at risk for worsened quality of life and increased mortality,” the team said.
The team used EHR data to identify cancer diagnosis, stage, type of treatment, duration of treatment at the time of enrollment, and demographic information such as race and income. This information helped the team identify which groups of patients would likely experience the most financial burden and related stress.
Patients with the most distress were underinsured, paying almost one-third of their income in health care-related costs. Stress from unexpected financial burdens was also associated with being younger, unmarried, nonwhite, unemployed/not retired, having lower household income, having a colorectal or breast cancer diagnosis, a lower quality of life, and higher financial distress.
The study concluded that cancer-cost knowledge and education should be a priority for stakeholders, who should test the impact of enhanced patient-facing interventions.
“The Institute of Medicine has listed cancer cost-related health literacy as a high priority for future research, and this priority has been included in the Center for Medicare and Medicaid’s Oncology Care Model, the team concluded. “Future studies should test interventions for cost mitigation through shared decision making.”