Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors

Abstract

This qualitative study explored cancer survivors’ experiences selecting and using health insurance and anticipating out-of-pocket care costs. Thirty individuals participated in semistructured interviews. On average, participants were 54 years ( SD ± 8.85, range 34-80) and diagnosed with cancer about 5 years prior (range 0.5-10 years). About 57% were female, 77% were non-Hispanic White, and 53% had less than a college education. Participants struggled to access information about health insurance and costs. Lack of cost transparency made it difficult to anticipate expenses and increased anxiety. Many participants were surprised that after cancer, care that was once preventive with no out-of-pocket costs became diagnostic with associated fees. They discussed the cognitive burden of managing finances on top of treatment and overseeing communication between doctors and insurance. Interventions are needed to clearly communicate information about insurance coverage and care costs to improve cancer survivors’ confidence in selecting health insurance and anticipating out-of-pocket expenses.

Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review

“…Our analysis of studies assessing HIL and health care utilization dovetails with other literature assessing the relationship between HIL and navigation of health insurance plan selection and affordability. Studies of factors influencing how people select insurance plans have shown that a lack of cost transparency 33 and a perceived lack of reliable information about how to distinguish different insurance plans 34 are significant barriers towards selecting a plan. One study found that individuals over the age of 50 with concerns about the affordability of health insurance were more likely to delay or avoid care.…”

Women Who Are Young, Non-White, and with Lower Socioeconomic Status Report Higher Financial Toxicity up to 1 Year After Breast Cancer Surgery: A Mixed-Effects Regression Analysis

“…Cancer centers could include resources either internally (e.g., financial navigators [39], which have been shown to reduce patients’ financial burden and anxiety and are recommended as part of treatment planning [40, 41]) or in in the region (e.g., certified application counselors or health insurance navigators) to discuss insurance options with patients [38, 42, 43]. For groups that are vulnerable to increased burden from care costs, facilitating insurance choices [35, 42–44] to best match their needs and providing broader social services could be needed. These services could be particularly relevant given the coronavirus pandemic and the high rates of unemployment, insurance loss, and subsequent financial hardship in the U.S. [45].…”

“…Screening for financial toxicity could identify vulnerable patients who could benefit from a referral to support staff to discuss care cost information [38]. Cancer centers could include resources either internally (e.g., financial navigators [39], which have been shown to reduce patients’ financial burden and anxiety and are recommended as part of treatment planning [40, 41]) or in in the region (e.g., certified application counselors or health insurance navigators) to discuss insurance options with patients [38, 42, 43]. For groups that are vulnerable to increased burden from care costs, facilitating insurance choices [35, 42–44] to best match their needs and providing broader social services could be needed.…”

Improving Cancer Patients’ Insurance Choices (I Can PIC): A Randomized Trial of a Personalized Health Insurance Decision Aid

“…The I Can PIC decision aid was developed using a mixed methods approach. The content was based on qualitative interviews with cancer survivors that explored the challenges they faced selecting and using health insurance [3]. It also included information that our study team reviewed and found important to plan selection.…”

“…Despite increasing access to health insurance after passage of the Affordable Care Act (ACA), patients with cancer and survivors often report inadequate insurance coverage and confusion when using insurance to offset health care expenses. Survivors cite high insurance costs [1,2], confusing plan details [3], and lack of available decision support [4] as barriers to finding, maintaining, and using adequate coverage. Inadequate health insurance compromises cancer treatment and impacts overall and cancer-specific mortality [5][6][7][8].…”