OOP Costs Greater for Cancer Patients in High-Deductible Health Plans

Patients with cancer enrolled in high-deductible health plans had higher out-of-pocket medical costs compared to those in traditional health plans, according to a study published in JAMA Oncology.

Patients with cancer often require long-term multispecialty follow-up care after receiving treatment to assess potential complications and address ongoing comorbidities. High-deductible health plans may hinder patients from accessing necessary care, as they must pay out-of-pocket until they meet their annual deductible.

Researchers used data from January 2003 to June 2017 from commercially insured members in the deidentified Optum Clinformatics Data Mart database to evaluate the association of high-deductible health plans with out-of-pocket medical costs and outpatient visits among patients with cancer.

They first identified patients who were enrolled in traditional low-deductible health plans during a baseline year. Patients whose employers mandated a switch to a high-deductible health plan were assigned to the high-deductible health plan group, while the rest were assigned to the control group.

There were 2,703 patients in the high-deductible health plan group and 43,005 control patients. The most common cancer types in both groups were breast, prostate, and colorectal cancer.

The high-deductible group saw a 68.1 percent increase in mean out-of-pocket medical costs from baseline to follow-up compared to the control group, translating to an increase of $1,349.80. Costs during the baseline period were higher for both groups due to the earlier phases of cancer. However, out-of-pocket costs remained high during the follow-up period for the high-deductible group, while costs declined for the control group.

Out-of-pocket costs from baseline to follow-up for patients enrolled in high-deductible plans went from $3,670.00 to $3,330.90. In contrast, out-of-pocket costs decreased from $3,844.90 to $2,075.50 from baseline to follow-up for the control group.

High-deductible health plan members had 10.8 percent fewer visits to primary care physicians and 5.9 percent fewer non-cancer specialist visits than members with low-deductible plans. The number of visits to oncology physicians did not differ significantly between the two groups.

The findings suggest that high deductibles may lead patients with cancer to prioritize oncology care while neglecting primary care and other healthcare services, leading to a lack of comprehensive care.

Primary care physicians can be essential to managing comorbid conditions, chronic pain, and psychosocial needs of patients with cancer. Additionally, non-oncology specialists can help address the late effects of cancer and its treatments, such as infertility, cognitive dysfunction, and cardiomyopathy.

A study from 2022 also highlighted the adverse impacts of high-deductible health plans on patients with cancer. Between 2008 and 2018, patients with colorectal cancer in high-deductible plans paid up to $865 more per month in out-of-pocket costs than those in traditional plans. Similarly, patients with breast cancer paid $860 more per month and patients with lung cancer paid $655 more per month.

Despite steep out-of-pocket costs, enrollment in high-deductible health plans among the general population has grown. In 2021, enrollment hit a record high, with 55.7 percent of American workers enrolled in a high-deductible health plan. These plans often attract individuals due to their low monthly premiums and may be best for those with minimal healthcare utilization.