Understanding the Financial Needs Following Diagnosis of Breast Cancer in a Setting with Universal Health Coverage

Abstract

Background A diagnosis of cancer negatively impacts the financial wellbeing of affected individuals as well as their households. We aimed to gain an in‐depth understanding of the financial needs following diagnosis of breast cancer in a middle‐income setting with universal health coverage. Materials and Methods Twelve focus group discussions (n = 64) were conducted with women with breast cancer from two public and three private hospitals. This study specifically focused on (a) health costs, (b) nonhealth costs, (c) employment and earnings, and (d) financial assistance. Thematic analysis was used. Results Financial needs related to cancer treatment and health care varied according to the participant's socioeconomic background and type of medical insurance. Although having medical insurance alleviated cancer treatment‐related financial difficulties, limited policy coverage for cancer care and suboptimal reimbursement policies were common complaints. Nonhealth expenditures were also cited as an important source of financial distress; patients from low‐income households reported transport and parking costs as troublesome, with some struggling to afford basic necessities, whereas participants from higher‐income households mentioned hired help, special food and/or supplements and appliances as expensive needs following cancer. Needy patients had a hard time navigating through the complex system to obtain financial support. Irrespective of socioeconomic status, reductions in household income due to loss of employment and/or earnings were a major source of economic hardship. Conclusion There are many unmet financial needs following a diagnosis of (breast) cancer even in settings with universal health coverage. Health care professionals may only be able to fulfill these unmet needs through multisectoral collaborations, catalyzed by strong political will. Implications for Practice As unmet financial needs exist among patients with cancer across all socioeconomic groups, including for patients with medical insurance, financial navigation should be prioritized as an important component of cancer survivorship services, including in the low‐ and middle‐income settings. Apart from assisting survivors to understand the costs of cancer care, navigate the complex system to obtain financial assistance, or file health insurance claims, any planned patient navigation program should also provide support to deal with employment‐related challenges and navigate return to work. It is also echoed that costs for essential personal items (e.g., breast prostheses) should be covered by health insurance or subsidized by the government.

Cancer and COVID-19: economic impact on households in Southeast Asia

“…Country-specific analyses revealed similar findings [ 16 – 18 ]. Our recent qualitative inquiry in a multiethnic population of Malaysian women with breast cancer had also revealed that unmet financial needs related to cancer treatment and healthcare might exist even among patients from high-income groups, as well as those with health insurance [ 19 ]. These needs range from financial assistance to cover out-of-pocket payments for medical and non-medical costs following cancer diagnosis, to navigation through the complex system to claim medical insurance or social security benefits, and return to work assistance.…”

“…Many cancer patients also face numerous issues while working following a diagnosis with cancer. We recently found that among Malaysian breast cancer survivors, besides experiencing catastrophic loss of household income, many recounted facing discriminations at the workplace due to their cancer [ 19 ], such as being forced to resign. It is not unthinkable that the pandemic may only have worsened the existing workplace discrimination when employers are forced to weigh in the organizational goals against the individual sufferings of employees with cancer.…”

Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals

“…The introduction of newer diagnostic, pharmacological, and treatment technologies coupled with the long-term care of cancer patients contributes towards a rapid escalation of cost [ 3 , 11 ]. On top of these, Malaysia’s public healthcare system also incorporates additional subsidies for the population above the age of 60 years, which forms most of the oral cancer incidences [ 12 ]. Consequently, the bulk of treatment costs will be borne by the Ministry of Health with minimal reimbursement from fee-for-service [ 7 ].…”

“…Consequently, the bulk of treatment costs will be borne by the Ministry of Health with minimal reimbursement from fee-for-service [ 7 ]. The recent implementation of the PeKa B40 scheme, which provides financial incentives for transport and the completion of cancer treatment further adds to this existing financial burden [ 12 ].…”

Study Protocol of an Open Labelled Randomised Controlled Trial of Perioperative Oral Nutrition Supplement in Breast and Colorectal Cancer Patients Undergoing Elective Surgery

“…The management of new cancer cases alone could amount to RM108 million (USD 26 million) per year excluding the costs for therapies, surveillance, and palliative care (2). Besides, patients may also experience loss of employment and earnings following the diagnosis of cancer (3). Surgery is the best hope of cure (2) and remains the preferred modality of treatment for cancer (4).…”