Cancer Costs Highest for Individually Insured

One of every seven cancer patients spends more than 20% of his income on health care and insurance, according to a new study from federal researchers.

Among these patients, those who buy private insurance on their own - instead of through an employer - pay the most out-of-pocket for their health care, compared to patients who have other forms of insurance or none at all.

"Looking at this," patients insured privately, and not through a group plan, have "an underinsured problem," said Dr. Didem Bernard, a senior economist at the Agency for Healthcare Research and Quality, and the lead author of the study.

Using surveys of about 4,200 people with cancer and roughly 149,000 people without, Bernard and her colleagues looked at incomes and out-of-pocket health care spending - including the cost of insurance premiums - among adults under the age of 65.

"It turns out that (people with cancer) have significantly higher burdens than not only people without cancer, but other chronic conditions," Bernard told Reuters Health.

The researchers found that 13% of cancer patients spent at least a fifth of their income on health care and insurance, compared to roughly 10% of people with chronic conditions and 4% of people without cancer or chronic diseases.

"This paper confirms previous reports that the out-of-pocket burden of cancer care can be substantial," said Dr. Neal Meropol, the chief of the division of hematology and oncology at University Hospitals Case Medical Center and Case Western Reserve University.

Meropol said that newer cancer-fighting agents can be extremely expensive.

Bernard also said that expenses for cancer patients might be higher than for people who have chronic diseases because of the myriad other issues that can be associated with cancer treatment. For example, some patients might require plastic surgery after a procedure to remove cancerous tissue, or a patient might be treated for depression, sparked by the stress of dealing with cancer. However, the study did not dig into the causes of cancer patients' higher out-of-pocket burdens. The study, which is published in the Journal of Clinical Oncology, included health care spending from 2001 to 2008.

Within the group of cancer patients, the research team also compared spending between people with different types of health coverage, including employer-sponsored group insurance, non-group insurance paid for by the individual or family, government-funded insurance for the poor (Medicaid), and no insurance.

Of people who had non-group health insurance, 43 out of every 100 spent more than 20% of their income on cancer treatment and insurance premiums.

In comparison, 26 out of every 100 people without insurance had high out-of-pocket costs, as did nine out of every 100 people whose employer paid for their insurance.

The finding that people without insurance didn't have the highest financial burden for cancer care "doesn't surprise me, because the uninsured are probably getting less treatment," Bernard said. Meropol, who was not involved in this study, said that people tend to use less health care when they are paying for it.

His concern is that high out-of-pocket costs could lead to people delaying or avoiding treatments. The actual dollar amounts of the out-of-pocket costs for some treatments were lowest for people who had employer-sponsored health insurance.

Those with employer-sponsored group insurance paid an average of $545 for ambulatory care, for instance, while those without any insurance paid $925, and people who bought their own non-group insurance paid $1,925.

The Affordable Care Act, which passed in 2010, mandates that citizens have insurance by 2014, and states will manage competitive health insurance "exchanges," aimed at making private non-group insurance more affordable.

The law has already established "high risk pools," which offer insurance to people with pre-existing conditions - including cancer - at relatively affordable rates.

Bernard says the law is likely to benefit people with cancer.

"For those who are uninsured currently or who have private non-group coverage, it should improve their situation, because those without insurance will be covered and those with non-group coverage can go into the exchanges, which will be more generous" than current coverage, Bernard said.

Critics of the law have said that an insurance requirement could be too burdensome for people who can't afford to pay the insurance premiums.

SOURCE: Journal of Clinical Oncology, online May 31, 2011.