In a study reported in the Journal of Oncology Practice, Zheng et al found that patients with cancer and high-deductible health plans had increases in delayed/forgone care, an effect that was attenuated for those with health savings accounts. Emergency department use was similar across insurance types, but higher among patients with vs patients without a history of cancer.
The study used the 2010 to 2017 National Health Interview Survey to identify privately insured adults aged 18 to 64 years who were cancer survivors (n = 4,321) or patients without a history of cancer (n = 95,316). Among cancer survivors, 1,130 had high-deductible health plans without health savings accounts, 550 had high-deductible health plans with health savings accounts, and 2,641 had low-deductible health plans.
Effect on Care and Emergency Department Use
Among cancer survivors, delayed/forgone care was identified for 13.9% of those with high-deductible health plans without health savings accounts (P < .001 vs low-deductible health plans), 8.9% of those with high-deductible health plans plus health savings accounts (P = .343 vs low-deductible health plans), and 7.6% of those with low-deductible health plans. Among the survivors with high-deductible health plans, the reduction in delayed/forgone care was significant among those with health savings accounts (P = .009). Emergency department visits were listed for 21.0% of survivors with high-deductible health plans without health savings accounts, 21.7% of those with high-deductible health plans plus health savings accounts, and 19.8% of those with low-deductible health plans (no significant differences among groups).
KEY POINTS
- Enrollment in a high-deductible health plan was associated with increased delayed/forgone care.
- The increase was attenuated among patients who also had a health savings account.
Among individuals without a cancer history, those with high-deductible health plans without health savings accounts (10.8%, P < .05 vs low-deductible health plans) and those with high-deductible health plans with health savings accounts (9.5%, P < .05 vs low-deductible health plans) were more likely to have delayed/forgone care vs those with low-deductible health plans (5.9%). Emergency department visits were listed for 15.3%, 13.4%, and 14.1% of those with high-deductible health plans without health savings accounts, high-deductible health plans with health savings accounts, and low-deductible health plans.
The investigators concluded, “High-deductible health plan enrollment and health savings account status affect access to care and hospital emergency department visits similarly by cancer history. High-deductible health plan enrollment may serve as a barrier to access to care among cancer survivors, although health savings account enrollment coupled with a high-deductible health plan may mitigate the impact on access. High-deductible health plans and health savings account status were not associated with emergency department visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce emergency department visits among privately insured cancer survivors.”
Zhiyuan Zheng, PhD, of the Surveillance and Health Services Research Program, American Cancer Society, Atlanta, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit jop.ascopubs.org.
