BACKGROUND AND PURPOSE:

• 46% of adults in the US <65 years have high-deductible health plans (HDHPs)
• Wharam et al. (Health Affairs, 2019) investigated the effects of HDHPs on breast cancer diagnosis and treatment, particularly in vulnerable populations such as low-income women

METHODS:

• Observational, longitudinal survival analysis study
• Participants: women ages 25–64
  • Exposure group: No evidence of breast cancer prior to baseline | Employed by companies who switched from low deductibles (≤$500) to HDHPs (≥$1,000)
  • Control group: Women whose employers kept low-deductible plans (matched for age categories, baseline out of pocket spending, breast cancer screening history, stage of cancer and treatment)
• The two primary income groups were matched
  • Low-income women: Those living in census tracts where at least 20% of households had incomes below the federal poverty level
  • High-income women: Those living in census tracts where fewer than 5% of households had incomes below poverty
• Subgroups
  • Nonmetropolitan regions | Metropolitan regions | Predominantly nonwhite areas | Predominantly white areas
• Primary outcomes
  • Time to the first observed diagnostic breast image
  • Time to first breast biopsy
  • Time to incident early-stage breast cancer diagnosis
  • Time to first breast cancer chemotherapy treatment

RESULTS:

• 54,403 low-income HDHP members | 534,735 controls
• 76,776 high-income HDHP members | 869,433 controls
• Low-income women in HDHPs experienced relative delays of
  • Time to first breast imaging: 1.6 months
  • Time to first biopsy: 2.7 months
  • Time to incident early-stage breast cancer diagnosis: 6.6 months
  • Time to first chemotherapy: 8.7 months
• Results were not significantly impacted by whether women were from low-or high income
• Other subgroup analyses
  • HDHP members living in metropolitan, nonmetropolitan, predominantly white, and predominantly nonwhite areas also experienced delayed breast cancer care

CONCLUSION:

• Both low- and high-income women experienced significant delays in necessary breast cancer testing, diagnosis, and chemotherapy treatment following an employer-mandated switch to a high-deductible health plan
• Future studies are required to determine long term impact on financial implications as well as stage and survival

Learn More – Primary Sources:

Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care

Related ObG Topics:

Is There a Relationship Between Patient Satisfaction and Health Care Utilization, Expenditures, and Mortality?

Waive the Copay and Wave Hello to Potential Legal Penalties

How Do Medical Insurance Deductibles, Coinsurance and Copays Work?

How Effective Is Mammography in Reducing the Number of Advanced Breast Cancer Diagnoses?