Cancer survivors enrolled in high-deductible health plans had significantly worse overall and cancer-specific survival than those in standard health plans, according to a study published Jan. 29 in JAMA Network Open.
The researchers analyzed data from 147,254 adults ages 18 to 84 who participated in the National Health Interview Survey from 2011 to 2018, linked to National Death Index mortality data through December 2019. Of those respondents, 9,799 were cancer survivors. About 25.6% of cancer survivors and 28.5% of adults without a cancer history reported being enrolled in an HDHP.
Five things to know:
- Among cancer survivors, HDHP enrollment was associated with a 46% higher risk of death from any cause and a 34% higher risk of cancer-specific death compared with standard plan enrollment, after adjusting for insurance status, income, education, comorbidities and other factors.
- The association was specific to cancer survivors. Among adults without a cancer history, HDHP status was not significantly associated with overall survival or cancer-specific survival.
- The study found financial barriers were a key driver. HDHP enrollment among cancer survivors was associated with more than double the odds of delaying or forgoing care due to cost, a 92% increase in cost-related medication underuse, and a 79% increase in concern about medical bills. Financial barriers mediated an estimated 30% to 70% of the association between HDHPs and worse survival.
- Having a health savings account did not appear to mitigate the survival risk. Cancer survivors with an HDHP paired with an HSA had a 68% higher risk of death, while those with an HDHP without an HSA had a 36% higher risk, compared with standard plan enrollees.
- HDHPs have grown from about 15% of employer-sponsored insurance enrollment in 2007 to roughly 40% in 2023. The study authors noted that in a political environment where HDHPs may continue to grow, the findings “suggest that HDHP proliferation could exacerbate adverse cancer outcomes” and that “insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.”
