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It is said that cancer is a great equalizer. Unfortunately, however, the same can’t be said about cancer care. Where you live, how much money you make, and the kind of health plan you have can determine if you will receive the care you need to manage your cancer in time.
A recent study conducted by Zhiyuan Zheng and coworkers at the American Cancer Society asked whether enrollment in a high deductible health plan (HDHP) and a health savings account (HSA) affect cancer survivorship and access to critical care.
An HDHP is a health care plan in the US with a significantly higher deductible ($1,350 for an individual and $2,700 for a family in 2019, on average) than a conventional plan. You pay less in premiums per month, but also foot a higher share (deductible) of health care costs before the insurance company starts covering expenses. You can pair HDHPs with an HSA, which allows you to pay for certain healthcare costs free from federal taxation.
Looking at self-reported data from the National Health Interview Survey, Zheng’s team found that enrollment in HDHPs without an HSA can result in worse access to care both for cancer survivors and for patients without a cancer history, when compared to individuals who are enrolled in a traditional low deductible health plan (LDHP). Having an HSA with an HDHP can offset this effect to some extent.
A quick peek at the numbers reveals the following: between 9% and 14% of cancer survivors enrolled in an HDHP with or without an HSA, respectively, were likely to have forgone or delayed care, statistically higher in each case when compared to patients with LDHPs (8%). When compared to individuals without a cancer history, the percentage of patients likely to experience delayed or forgone care stood at about 9% and 11%, respectively, for those enrolled in an HDHP with or without HSA. Whereas for those enrolled in an LDHP, the percentage of patients likely to experience delayed care stood at about 6%, much lower in comparison to HDHP patients.
While the study demonstrates the impact of the health plan on medical care for cancer patients, the retrospective aspect of the data raises some critical questions. Firstly, it is not clear why individuals were enrolled in an HDHP plan as opposed to an LDHP plan, to begin with. Was it because of low insurance premiums, or because of the limited options provided by the employer? Secondly, what are the differences in the financial capability of individuals enrolled in an HSA versus those who are not?
Som Roy, a Senior Manager in Healthcare Advisory Services at PricewaterhouseCoopers LLP, suggests, “An HDHP can easily have yearly out-of-pocket expenses of $5,000 before the benefits/plan kicks in. This may cause individuals with HDHP to delay check-ups, screenings, and other preventive services.” He further adds, “Typically, with a cancer diagnosis, the cost of procedures shoots up, and for someone diagnosed with the disease, the costs can be crippling – HSA helps tide over this initial spike in costs.” Moreover, “People enrolled in HSA typically want to take better care of themselves and are financially aware.” It is true that HSA enrollment is shown to mitigate delayed or forgone access to care; however, it is not clear if an improvement in financial awareness can expand the benefit to people with low incomes or major health costs. These individuals cannot always afford to put money on an HSA after sharing the burden of high out-of-pocket expenses. High-income households appear to be the biggest beneficiary of HSAs, with generous tax benefits.
While the health plans and the schemes discussed in this study are US-specific, the findings of this study show the importance of health care plans, financial security and awareness, in guiding access to treatment for both cancer survivors and individuals without a cancer history. Cancer remains a great equalizer. Cancer care still isn’t!
Edited by Sara Musetti
Zheng, Z., Jemal, A., Banegas, M. P., Han, X., & Yabroff, K. R. (2019). High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use? J Oncol Pract, JOP1800699. doi: 10.1200/JOP.18.00699
How to Pick the Right Health Insurance Plan, https://www.flickr.com/photos/138199727@N03/26701737301