Breast cancer patients with high-deductible health plans see delays in diagnosis, treatment

High-deductible health plans (HDHPs) are associated with numerous delays in care for patients with breast cancer, according to new research published in Health Affairs.

“In contrast to breast cancer screening, which has little or no associated cost sharing even in HDHPs, breast cancer diagnosis and treatment require the use of expensive services,” wrote lead author J. Frank Wharam, associate professor at Harvard Medical School, and colleagues. “Therefore, women in HDHPs who face decisions about breast cancer care must weigh the costs of services against the possibility of delaying diagnosis and treatment for a potentially life-threatening disease.”

The authors examined data from than 300,000 women between the ages of 25 and 64 who had no prior evidence of breast cancer. All patients were switched from a health insurance plan with a low deducible to one with a high deducible (at least $1,000) by their employer. These patients were then compared to a control group of more than three million women who had low-deductible plans.

Overall, low-income women who were switched to HDHPs experienced relative delays of 1.6 months for diagnostic breast imaging compared to women with low-deductible plans. Other delays included 2.7 months for breast biopsy, 6.6 months for early-stage breast cancer diagnosis and 8.7 months for first chemotherapy.

While high-income women did have slightly shorter delays, it was an insignificant difference. The study’s authors noted they were surprised that high-income women experienced these delays. Previous research had found that low-income women with HDHPs, but not high-income women, experienced delays when seeking care for acute diabetes complications. So what made the circumstances different when examining breast cancer patients?

“The different findings could be related to diabetes patients’ greater familiarity with health insurance and benefit designs,” Wharam and colleagues wrote. “Patients with chronic medical conditions often interact with their health insurance and the health system regularly, while the women in our study were generally healthy and initially free of breast cancer. Thus, the majority of HDHP members in this study may have had little experience navigating complex, high-cost health insurance designs.”

The researchers observed that these findings suggest more and more women will end up experiencing delays in breast cancer care. Healthcare providers can fight against this trend, they wrote, by making sure someone speaks to women when they receive breast cancer screening to ask about their health plan and emphasize that it is important to always present for symptoms of possible breast cancer.

“Financial discussions may become essential in the care of women at high risk for breast cancer,” the authors wrote. “Employers could also include information about HDHPs and delayed cancer care in their workplace wellness and insurance benefits education programs.”

Looking at possible long-term solutions, Wharam et al. said health plans must be developed that help patients transition from one “key step” to the next when they are being treated for cancer.