Breast cancer care delayed for women in high-deductible plans, study finds

Low-income and high-income women who were switched to high-deductible health plans experienced delays in breast cancer diagnostic testing, early stage diagnosis and chemotherapy initiation, compared to women remaining in low-deductible plans, according to a study published in Health Affairs.  

The study — led by J. Frank Wharam, an associate professor and director in the population medicine department at Harvard Medical School in Boston — examined claims data from a large national insurer for 316,244 women whose employers switched their insurance coverage from low-deductible health plans ($500 or less) to high-deductible plans ($1,000 or more) between 2004 and 2014.

The study found that low-income women in high-deductible health plans 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 women also experienced relative delays (0.7 months to first breast imaging, 1.9 months to first biopsy, 5.4 months to incident early-stage breast cancer diagnosis, and 5.7 months to first chemotherapy).

Researchers found breast cancer care delays among women in high-deductible health plans living in metropolitan, nonmetropolitan, predominantly white and predominantly nonwhite.

"Such delays could lead to adverse long-term breast cancer outcomes affecting a substantial proportion of commercially insured women who develop breast cancer," the study authors concluded. "Policymakers, health insurers and employers should consider implementing value-based features in HDHPs to encourage successful transitions through key stages of the cancer care pathway."


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