Research shows that the United States’ health-care delivery and financing system is so complex that streamlining administrative costs alone could reduce total health-care spending by 15%. In addition, health insurance payment and medical billing processes are time-consuming and expensive for both providers and patients. Cost-sharing between payers and patients has resulted in financial difficulties for patients, which can result in harmful cost-coping practices, such as treatment nonadherence and worse health-related quality of life.

A study by Doherty et al published in Cancer Epidemiology, Biomarkers & Prevention investigating the relationship between the payment tasks patients engage in to pay for their health care and timely access to cancer care has found that the administrative payment burden increased the odds of cost-related delays and nonadherence to treatment by 49% for patients with cancer. The study also found that younger and Black patients were more likely to engage in administrative tasks to pay for their health care and to delay or forgo care due to cost.

Study Methodology

The researchers analyzed online survey data collected by CancerCare from 510 patients with cancer and survivors to understand the relationship between administrative payment tasks and cost-related delays and nonadherence to treatment. Half of the participant population was selected from patients or survivors who had breast, colorectal, lung, or prostate cancers; the other half of the population comprised patients or survivors with another type of cancer.

Two-part modeling was used to determine if and to what extent there was a relationship between administrative burden and cost-related delays or nonadherence.

Participants were asked if they never, rarely, sometimes, often, or always participated in the following activities during their cancer care.

Administrative burdens:

• Estimated the out-of-pocket costs before agreeing to treatment
• Appealed a denial of benefits from an insurance company
• Found out the out-of-pocket costs before filling a prescription
• Asked an insurance company for help understanding coverage
• Found out the out-of-pocket cost before getting a lab test or scan.

Treatment delay or nonadherence behaviors:

• Postponed or skipped doctors’ appointments
• Postponed or skipped follow-up testing
• Postponed or skipped blood work
• Postponed or skipped filling prescriptions
• Skipped doses of prescribed drugs.

Results

The researchers found that younger patients (≤ 44 years) reported more payment tasks and cost-related delays/nonadherence than older patients (≥ 55 years). Black patients reported more payment tasks and cost-related delays or nonadherence than White patients. After accounting for age, race/ethnicity, education, and out-of-pocket costs, patients who reported engaging in more tasks had greater log odds of delaying or forgoing care (b = 0.18, 95% confidence interval [CI] = 0.12–0.24). Cost-related delays or nonadherence increased by 32% for every unit increase in administrative payment burden (b = 0.32, 95% CI = 0.18–0.46).

“Administrative payment burden increased the odds of cost-related delays and nonadherence by 49%, taking the form of delayed or skipped doctor appointments, tests, and bloodwork, and prescription fulfillment. Younger patients and those identifying as [Black] were more likely to engage in payment tasks and to delay or forgo care due to cost. Administrative burdens can disrupt access to care and traditionally underserved patient populations are disproportionately exposed to these hardships,” concluded the study authors.

Bearing the Cost Burden of Cancer

In a statement explaining that the burden of learning about the costs of care and fixing billing errors often falls to the patient, lead study author Meredith Doherty, PhD, LCSW, Assistant Professor in the School of Social Policy and Practice at the Penn Medicine Center for Cancer Care Innovation, said, “It’s fairly unique to our for-profit U.S. health-care system for the consumer to be responsible for acquiring the knowledge and skills needed to effectively use those goods or services and to ensure they’re of high quality. In the United States, health care is largely treated as a consumer product, so the onus is on the consumer.”

Disclosure: Funding for this study was provided by the American Cancer Society. For full disclosures of the study authors, visit aacrjournals.org/cebp.