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Money Woes, Out-of-Pocket Patient Costs Limit Cancer Care

Patients are overwhelmed and shocked by high out-of-pocket patient costs associated with cancer care, research shows.

Healthcare consumers experience sticker shock when seeing out-of-pocket patient costs tied to cancer care.

Source: Thinkstock

By Sara Heath

- Sixteen percent of healthcare consumers are experiencing high or overwhelming financial distress as a result of high out-of-pocket patient costs for cancer care. This can ultimately impact patient willingness or ability to access treatment, according to a research team from Duke University Medical Center.

The team, which published a research note in the August 10th edition of JAMA Oncology, reported that patients are experiencing some sticker shock when it comes to their cancer treatments. Patients reportedly anticipate smaller patient financial responsibility than they end up facing.

This concern is shared amongst patients regardless of their insurance status or payer type, the team said. Even patients with private insurance are feeling the pinch.

“The financial burden of cancer treatment is a well-established concern,” the team explained in the research letter. “Owing to cost sharing, even insured patients face financial burden and are at risk for worsened quality of life and increased mortality.”

The researchers surveyed over 300 patients with health insurance and who were undergoing cancer treatment. The survey assessed patients’ out-of-pocket cancer treatment costs, how much patients were willing to pay for treatment, and patients’ financial distress level. These survey questions were synthesized to consider the impact of unexpected out-of-pocket cancer care costs.

The survey also asked about patient demographic information and insurance information.

Sixteen percent of the patients reported high or overwhelming financial distress. Thirty-nine percent of patients reported out-of-pocket cancer care costs that were higher than they expected, even with a premium kicking in.

Patients with higher unexpected costs tended to be single, younger, non-white, unemployed, have a lower household income, and have higher levels of financial distress.

Respondents presenting with high or overwhelming financial distress were spending nearly one-third of their household income on healthcare bills, not including their insurance premiums. Sixty percent of these patients had private insurance.

Healthcare consumers with little or no financial distress were spending only 10 percent of their household incomes on out-of-pocket cancer treatment costs, the researchers reported. Over half of these patients had private insurance, and 39 percent had publicly subsidized health insurance.

The team also discovered a high underinsured rate amongst survey respondents. Being underinsured means out-of-pocket patient costs exceed 10 percent of total patient costs. In other words, private insurance covers 90 percent or less of healthcare costs.

On average, out-of-pocket costs accounted for 11 percent of survey respondents’ healthcare costs.

Higher unexpected out-of-pocket costs and financial distress were also tied with an unwillingness to pay more for cancer treatments, the researchers found. This “financial toxicity,” as the researchers called it, can lead to poorer healthcare decision-making. Patients may be more likely to refuse certain treatments because of cost restrictions, paying both a mental and physical toll.

“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,” the researchers wrote. “Future studies should test interventions for cost mitigation through shared decision making.”

Evidence that high cancer care costs are impacting patient healthcare decisions should spark a movement to help financially support patients. Financial and cost literacy programs will be essential, as will cost transparency efforts, the researchers said.

“This study adds to the growing evidence that we need to intervene,” said senior author Yousuf Zafar, MD, medical oncologist at Duke. “We know there are a lot of barriers that prevent patients from talking about cost with their providers. We need to create tools for patients at risk of financial toxicity and connect them with resources in a timely fashion so they can afford their care.”

Patients managing other illnesses are also grappling with rising financial responsibility and a growing concern about paying for necessary treatments. One survey from Consumer Reports Best Buy Drugs found that 24 percent of patients are worried about being able to pay for their medications in the future.

A separate survey from the American College of Emergency Physicians found that one-quarter of patients who skimp on healthcare due to rising costs also see poor outcomes. Patients strapped for cash are going without critical care interventions, the survey found, leading to negative outcomes and more escalated (and costly) interventions in the future.

The healthcare industry will continue to face issues surrounding patient healthcare costs and treatment affordability. In the short-term, hospitals can work to offer better price transparency and other retail strategies that will cut down on sticker shock and assist patients in managing their finances to facilitate treatment access.

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