High-Deductible Insurance Associated With Delayed Breast Cancer Care

A study published in Health Affairs found that high out-of-pocket costs for patients with breast cancer are delaying diagnosis and treatment. “Policies may be needed to reduce out-of-pocket spending obligations for breast cancer care,” according to the researchers.

Researchers assessed time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among women whose employers switched their insurance from low-deductible health plans ($500 or less) to high-deductible health plans ($1,000 or more) between 2004 and 2014.

The cohort included 54,403 low-income and 76,776 high-income women continuously enrolled in low-deductible plans for a year who were switched to high-deductible plans for up to four years. These patients were matched with a control cohort that had low-deductible plans for comparison.

High- and Low-Income Earners Impacted by High Deductibles

Women with both high and low incomes in the high-deductible cohort experienced increases in overall out-of-pocket medical spending that ranged from 47% to 72% for each follow-up year compared with baseline relative to control participants.

Low-income women in high-deductible plans experienced relative delays of 1.6 months to first breast imaging, 2.7 months to first biopsy, 6.6 months to incident early-stage breast cancer diagnosis, and 8.7 months to first chemotherapy. High-income women in high-deductible plans had shorter delays in breast cancer care, but the delays were not significantly different from the low-income cohort. High-income women in high-deductible plans experienced relative delays of less than one month to first breast imaging, 1.9 months to first biopsy, and 5.4 months to first chemotherapy.

These delays in breast cancer care persisted in the high-deductible plan cohort regardless of area in which they lived or predominant race of the area.

Researchers did not assess reasons for the delays, which is a limitation of the study.