In a study reported in JAMA Oncology, Trad et al found that individuals with cancer in the United States who were switched from low- to high-deductible employer-sponsored health plans had higher out-of-pocket costs but no reduction in the number of oncologist visits; these patients, however, had fewer visits to other physicians.
Study Details
The study used 2003 to 2017 data from the de-identified Optum Clinformatics Data Mart database on individuals with employer-sponsored health coverage; those aged 18 to 64 years with cancer who were enrolled in low-deductible health plans (≤ $500 annually) during a baseline year were identified. Patients whose employers then mandated a switch to a high-deductible health plan (HDHP; ≥ $1,000 annually) were assigned to the HDHP group. Contemporaneous individuals with cancer at baseline who had no option but to continue enrollment in low-deductible plans were assigned to the control group.
The two patient groups were matched for demographic variables (age, sex, race and ethnicity, U.S. Census region, rural vs urban, and neighborhood poverty level), cancer type, morbidity score, number of baseline physician visits by specialty type, baseline out-of-pocket costs, and employer characteristics. The matched cohorts were followed for up to 3 years.
Key Findings
After matching, the analysis population included 45,708 patients with cancer, consisting of 2,703 patients in the HDHP group and 43,005 matched patients in the control group. Patients who were switched to HDHPs exhibited an increase in annual out-of-pocket medical expenditures of 68.1% (95% confidence interval [CI] = 51.0%–85.3%), representing an absolute increase of $1,349.80 (95% CI = $1,060.30 to $1,639.20) after the switch compared with those in the control group.
At follow-up, the mean cumulative number of oncology visits per patient was 6.3 in the HDHP group vs 6.3 in the control group (relative difference = 0.1%, 95% CI = −8.4% to 9.4%). The HDHP group had 10.8% (95% CI = −15.5% to −5.9%) fewer visits to primary care physicians (mean cumulative number of visits per patient = 6.7 vs 7.6) and 5.9% (95% CI = −11.2% to −0.3%) fewer visits to noncancer specialists (mean cumulative number of visits per patient = 9.9 vs 10.5).
The investigators concluded, “Results of this cohort study suggest that after enrollment in HDHPs, patients with cancer experienced substantial increases in out-of-pocket medical costs. The number of visits to oncologists was unchanged during follow-up, but the number of visits to noncancer physicians was lower. These findings suggest that HDHPs are unlikely to unfavorably affect key oncology services but might lead to less comprehensive care of cancer survivors.”
Nicolas K. Trad, MD, of Massachusetts General Hospital, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the National Cancer Institute and others. For full disclosures of the study authors, visit jamanetwork.com.
