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

The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among a group of women whose employers switched their insurance coverage from...

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Bibliographic Details
Published in:Health Affairs 2019-03, Vol.38 (3), p.408-415
Main Authors: Wharam, J. Frank, Zhang, Fang, Wallace, Jamie, Lu, Christine, Earle, Craig, Soumerai, Stephen B., Nekhlyudov, Larissa, Ross-Degnan, Dennis
Format: Article
Language:English
Subjects:
Algorithms
Biopsy
Breast cancer
Cancer
Censuses
Chemotherapy
Cost control
Delayed
Diabetes
Diagnosis
Diagnostic systems
Diagnostic tests
Employers
Enrollments
Ethnicity
Expenditures
Failure analysis
Health care policy
Health insurance
Health maintenance organizations
Health savings accounts
Health services
High income
HMOs
Households
Income
Insurance coverage
Low income groups
Mammography
Medical diagnosis
Medical screening
Medical treatment
Medicare
Neighborhoods
Personal expenditure
Population
Poverty
Public health
Subgroups
Survival analysis
Vulnerability
Women
Womens health
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Summary:The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among a group of women whose employers switched their insurance coverage from health plans with low deductibles ($500 or less) to plans with high deductibles ($1,000 or more) between 2004 and 2014. Primary subgroups of interest comprised 54,403 low-income and 76,776 high-income women continuously enrolled in low-deductible plans for a year and then up to four years in HDHPs. Matched controls had contemporaneous low-deductible enrollment. Low-income women in HDHPs experienced relative delays of 1.6 months to first breast imaging, 2.7 months to first biopsy, 6.6 months to incident early-stage breast cancer diagnosis, and 8.7 months to first chemotherapy. High-income HDHP members had shorter delays that did not differ significantly from those of their low-income counterparts. HDHP members living in metropolitan, nonmetropolitan, predominantly white, and predominantly nonwhite areas also experienced delayed breast cancer care. Policies may be needed to reduce out-of-pocket spending obligations for breast cancer care.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2018.05026