Effect of High-Deductible Insurance Enrollment on Breast Cancer Diagnosis and Treatment


Key Points

  • Switch from a low-deductible to high-deductible insurance was associated with delays in diagnostic imaging and biopsy vs controls.
  • The switch was also associated with delay to early breast cancer diagnosis and initiation of chemotherapy.


In a study reported in the Journal of Clinical Oncology, Wharam et al found that women who were switched from low-deductible to high-deductible insurance policies had delays in diagnostic workup, early breast cancer diagnosis, and initiation of chemotherapy compared with those maintained on low-deductible insurance.

Study Details  

The study involved data from commercially insured members in the deidentified Optum database enrolled between January 2003 and December 2012, including 273,499 women aged 25 to 64 years without evidence of breast cancer before inclusion. They were continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a high-deductible plan (at least $1,000) after an employer-mandated switch.

A comparison group consisted of 2.4 million contemporaneously matched women with employers offering only low-deductible plans. The beginning of the month of the low- to high-deductible switch was defined as the index date.

Diagnosis and Treatment Delays

In analysis adjusted for age group, morbidity score, poverty level, U.S. region, index date, and employer size, after the index date, women who switched from low-deductible to high-deductible plans had delays in diagnostic imaging (1.2-month delay, adjusted hazard ratio [aHR] = 0.95, 95% confidence interval [CI] = 0.94–0.96), biopsy (2.1-month delay, aHR = 0.92, 95% CI = 0.89–0.95), early-stage breast cancer diagnosis (5.8-month delay, aHR = 0.83, 95% CI = 0.78–0.90), and chemotherapy initiation (7.4-month delay, aHR = 0.79, 95% CI = 0.72–0.86) compared with the control group.

The investigators concluded, “Women switched to [high-deductible health plans] experienced delays in diagnostic breast imaging, breast biopsy, early-stage breast cancer diagnosis, and chemotherapy initiation. Additional research should determine whether such delays cause adverse health outcomes, and policymakers should consider selectively reducing out-of-pocket costs for key breast cancer services.”

The study was supported by the National Cancer Institute and National Institutes of Health.

J. Frank Wharam, MB, BCh, BAO, of the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.