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ASCO: Economics of healthcare delivery getting more complex for cancer patients and survivors


There are three aspects to medical financial hardship: material, psychological, and behavioral. They all can impact adherence to physician treatment plans and follow-up care.

Cancer survivors can experience lasting effects of the disease, treatment, and the economic realities relating to the costs of care.

Not only are cancer survivors more prone to developing additional cancers and other chronic conditions, but this segment of the population also has more significant health expenditures and a higher risk of bankruptcy, says Robin Yabroff, senior scientific director of Health Services for the American Cancer Society. Yabroff made the comments in a presentation at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

The escalating costs of care and variety of treatment options, Yabroff adds, have been conversely met with the growth of high-deductible health insurance plans. Escalating costs of care, coupled with higher out-of-pocket expenditures, are creating new economic realities for healthcare providers, payers, and its customers.

Just a decade ago, she says, less than 10 percent of the population was enrolled in high-deductible health plans. Today, the number of high-deductible health plan enrollments has grown to 40 percent of working adults.

"There is increasing research that shows those individuals on high-deductible health insurance plans are less likely to receive prevention, more likely to be diagnosed with later-stage disease. And they also, not surprisingly, have higher out-of-pocket spending." People with private health insurance are seeing higher copayments too. Co-insurance for specialty drugs, which are common for cancer patients, is about 30 percent typically. There is a growing population of people considered underinsured and another cohort without prescription drug coverage at all, she says.

When you begin to examine the economics of cancer care, there has been a dramatic shift in median monthly costs of new cancer drugs at approval. In 2010 and beyond, some drugs now cost $60,000 a month. Other cancer care services–like supportive agents, additional imaging, hospitalization, surgery, radiation, and other types of treatment–add to the escalating costs of care.

There are three different aspects of medical financial hardship, Yabroff explains, material, psychological, and behavioral. They all can impact adherence to treatment recommendations and follow-up care, she says.

"Because we have this consistent evidence about patient factors associated with hardship, there's an increasing concern for widening disparities in cancer outcomes when we look at care for cancer patients. So many of these factors I listed here are also associated with lower survival and higher mortality in cancer patients. And because of some of the additional pressures we're starting to see in terms of higher cost and greater patient cost sharing among the insured, it's entirely possible we'll have greater disparities going forward."

Solving the economic challenges facing healthcare are complex and will require a thoughtful approach to reducing hardship with patients and families in the center, provider teams, local communities, states, federal health policy change, and employers.

Medicaid expansion has helped, Yabroff says. In 2010-2014 when states began to expand Medicaid, those people experiencing the highest level of poverty were less likely to be diagnosed without health insurance coverage, than those in non-expansion states.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health