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Grand Rounds

High-Deductible Health Care Plans and Delayed Breast Cancer Treatment

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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

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