Out-of-Pocket Healthcare Costs Discourage Follow-Up Care for Insured
Even for patients with insurance and above-average incomes, high out-of-pocket healthcare costs stand in the way of follow-up care for cancer survivors.
May 27, 2021 – High out-of-pocket healthcare costs are hampering patient engagement in follow-up care, even among some of the most privileged cancer survivors, a new study from the Medical College of Georgia at Augusta University.
The data showed that 10 percent of cancer survivors, even those with insurance, a college education, and an above-average income, do not engage in follow-up care because of high patient financial responsibility. Particularly, patients expressed concern about being able to afford co-pays and deductibles, the researchers found.
This comes as the healthcare industry grapples with the rising cost of patient care. Patients have increasingly become some of the primary payers for their own medical care, but with costs out-of-reach for so many, this creates a care access problem. Previous data has shown patients do not always access medical care because of the high cost associated with it.
“It is likely that these percentages are much higher among cancer survivors in the general population, and particularly among minorities and other populations suffering significant health disparities in general,” Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the MCG Department of Population Health Sciences, said in a statement.
The researchers looked at care access information for just under 5,500 patients who contributed their data to the All of Us Research Program, a group that disproportionately skews wealthier, more insured, and more educated. Of those patients, 10 percent avoided follow-up cancer survivorship care, which most experts agree is essential for keeping cancer survivors healthy through the duration of their lives.
READ MORE: Top Challenges Impacting Patient Access to Healthcare
Survivorship follow-up care is key for preventive screenings and detecting relapse.
Most patients who skipped their survivorship follow-up care said they would have had to pay out-of-pocket for the procedure. This comes despite the fact that most of the respondents were insured; 47 percent had private insurance, 41 percent had Medicare coverage, 6 percent were Medicaid beneficiaries, and the remainder had military, VA, or no insurance.
And even for those whose insurance would have kicked in, the costs associated with that coverage were likewise in the way. Many patients reported that the deductible for survivorship follow-up care was too high or that they could not afford the deductible.
Less frequent responses include being nervous to see a provider for survivorship follow-up care and not being able to get time off work.
These findings are striking because the surveyed population represented some of the more privileged cancer survivors, the researchers noted. A notable 12.1 percent of the US population is uninsured, the team said citing CDC figures, a far cry from the uninsured rate of the surveyed population. People included in the study also had a higher income—half reported earning more than $75,000 annually compared to the median US income at $68,703.
READ MORE: Top Challenges to Collecting Patient Financial Responsibility
As Coughlin noted above, it stands a chance that care access delays due to high costs are likely more common when looking at the general population.
The data did not reveal particularly striking differences in care access avoidance between White and non-White participants, although the study population did skew overwhelmingly White (about 88 percent of participants.) However, given prior literature, the researchers anticipate that care access racial health disparities exist.
“You can imagine that if you go to these populations that are still grossly under-represented in many of these types of surveys, such as African Americans, Hispanics, and individuals who live in more rural communities, these problems are probably magnified tenfold if not more,” Dr. Jorge E. Cortes, director of the Georgia Cancer Center and a study coauthor, said in the press release.
“Health disparities are pervasive, people across the country struggle to make ends meet and to afford their survivorship care,” added Coughlin, who previously worked for the Centers for Disease Control & Prevention.
Patient engagement in cancer survivorship follow-up care is critical for staving off relapse and other illness, the researchers emphasized. Cancer can come with chronic comorbidities—between 10 and 20 percent of breast cancer survivors have diabetes, for example—so helping patients to overcome care access barriers should be top-of-mind.
READ MORE: 93% of Patients Negotiate Out-of-Pocket Patient Costs, Debt Away
Coughlin and Cortes recommended outlining survivorship follow-up care importance as early as cancer diagnosis. Setting up expectations early can help both patient and provider manage barriers, like cost.
“You cannot prevent the impact that a diagnosis of cancer can have emotionally on somebody,” Cortes explained. “We are all humans and it has a big impact, but maybe you can provide the assistance to help the patient navigate the impact that it can have.”
“Some people have lifelong commitments because of the investment they had to make to pay for their treatment, so now they are cured but they are in debt, they may have lost their job, there may be strains that developed in their personal and family relationships,” Cortes concluded. “Assessment and management of all these aspects of the patient as a whole have been incorporated into this science of survivorship, which is an integral part of cancer care nowadays.”
Source: Patient Engagement Hit By Sara Heath