Financial Access Barriers to Health Care Increase Out-of-Pocket Costs, Productivity Loss

During a podium session at the ISPOR annual meeting, Kevin Lu, PhD, University of South Carolina, explained why there is an urgent need to address financial burden or barriers among cancer survivors. 

Dr Lu identified the percentages of new cancer cases and cancer-related deaths in 2018 at the top of the session. According to Dr Lu, lung cancer is the top of both the incidence and mortality lists. Other common cancer types include breast, colorectal, prostate, stomach, and liver. 

He explained that in 2016, there were 15.5 million Americans who were identified to have a history of cancer and were referred to as a “cancer survivor.” He noted that the number of cancer survivors is expected to increase yearly, and it is expected that there will be 20.6 million survivors by 2026. Dr Lu said that this increase in survivors is largely because of the aging of population and improvements in cancer care. 

Although the number of cancer survivors is increasing, treatments for cancer can be expensive, according to Dr Lu, and this often leads to financial burden for patients and their families. This financial burden can lead to health care access problems for these patients. 

“Medicare spends $209.9 billion on cancer annually,” Dr Lu noted. 

Based on the currently known background of cancer care and its related costs, Dr Lu and his colleagues sought to better understand the effect of financial access barriers on both out-of-pocket costs and productivity loss among cancer survivors. 

According to a literature review that was performed by Dr Lu and his team, financial hardship that stands in the way of a patient obtaining “heal services” is associated lower health-related quality of life and it is becoming more common. These financial barriers among cancer survivors often lead them to delay overall medical care, forgo overall medical care, and forgo medications. 

Although Dr Lu and his colleagues found that patients with a history of cancer experience financial hardships, a research gap remained. He said that their literature review showed “no evidence on the effect of financial access barriers on cancer survivors’ out-of-pocket costs and productivity loss in the US.” 

To understand how these financial access barriers impacted this patient population, the research team conducted a cross-sectional study. They used the National Health Interview Survey to obtain their data and they only included patients 18 years of age or older. Dr Lu and his team conducted this study from 2011 through 2017. 

They measured productivity loss among the study participants based on work loss days in the prior 12 months. 

The research team asked the participants a number of yes/no statements relating to health care. Some of these statements included: 

• Needed but couldn’t afford medical care; 
• Needed but couldn’t afford follow-up care; 
• Needed but couldn’t afford mental health care; and, 
• Needed but couldn’t afford specialists. 

The first model in the researcher’s study design was ordered logistic regression for out-of-pocket costs. The dependent variable of the model was the out-of-pocket costs. The costs were defined as less than $2000, between $2000 to $5000, and greater than $5000. The explanatory variable was whether a patient had financial access barriers or not, and some of the covariates of the model included: 

• Patient demographics (age, gender, race, religion, marital status); 
• Education status; 
• Health status; 
• Body mass index; and, 
• Insurance status (defined as public or private health care insurance). 

The second model used in the study was a negative binomial regression for productivity loss. The research team looked to see if work loss over the prior 12 months was due to financial access barriers. Similar to model 1, the research team utilized the same covariates for this model. 

Of 22,338 identified survivors, 5845 had financial access barriers and 16,493 did not. According to the findings, patients who experienced more financial access barriers also experienced higher out-of-pocket costs and productivity loss. 

Dr Lu explained that cancer survivors with financial access barriers were more likely to lose productivity by 16% and also have an increased probability of paying a higher level of out-of-pocket costs by 56%. 

“Our study provides important evidence to decision-makers about the impact of financial consequence on cancer,” Dr Lu said. “There is an urgent need to identify strategies to address financial burden or barriers.”—Julie Gould