Medical financial hardship among cancer survivors in the United States
Background The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States. Methods The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18‐49 years [1424 survivors], ages 50‐64 y...
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| Veröffentlicht in: | Cancer Jg. 125; H. 10; S. 1737 - 1747 |
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| Hauptverfasser: | , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Wiley Subscription Services, Inc
15.05.2019
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| ISSN: | 0008-543X, 1097-0142, 1097-0142 |
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| Abstract | Background
The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.
Methods
The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18‐49 years [1424 survivors], ages 50‐64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18‐64 years [66,951 individuals], ages 50‐64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18‐64 years only).
Results
Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18‐49 years: 43.4% vs 30.1%; ages 50‐64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18‐49 years: 53.5% vs 47.1%), and behavioral (ages 18‐49 years: 30.6% vs 21.8%; and ages 50‐64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18‐49 years and 50‐64 years; all P < .01). Among privately insured survivors, having a high‐deductible health plan without a health savings account was found to be associated with greater hardship compared with having low‐deductible insurance.
Conclusions
Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design.
Cancer survivors encounter greater medical financial hardship compared with individuals without a cancer history in material, psychological, and behavioral domains, with the greatest hardships observed in younger populations. Among privately insured survivors, having a high‐deductible health plan without a health savings account is associated with greater medical financial hardship. |
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| AbstractList | Background
The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.
Methods
The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18‐49 years [1424 survivors], ages 50‐64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18‐64 years [66,951 individuals], ages 50‐64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18‐64 years only).
Results
Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18‐49 years: 43.4% vs 30.1%; ages 50‐64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18‐49 years: 53.5% vs 47.1%), and behavioral (ages 18‐49 years: 30.6% vs 21.8%; and ages 50‐64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18‐49 years and 50‐64 years; all P < .01). Among privately insured survivors, having a high‐deductible health plan without a health savings account was found to be associated with greater hardship compared with having low‐deductible insurance.
Conclusions
Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design.
Cancer survivors encounter greater medical financial hardship compared with individuals without a cancer history in material, psychological, and behavioral domains, with the greatest hardships observed in younger populations. Among privately insured survivors, having a high‐deductible health plan without a health savings account is associated with greater medical financial hardship. The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.BACKGROUNDThe current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18-49 years [1424 survivors], ages 50-64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18-64 years [66,951 individuals], ages 50-64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18-64 years only).METHODSThe 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18-49 years [1424 survivors], ages 50-64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18-64 years [66,951 individuals], ages 50-64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18-64 years only).Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18-49 years: 43.4% vs 30.1%; ages 50-64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18-49 years: 53.5% vs 47.1%), and behavioral (ages 18-49 years: 30.6% vs 21.8%; and ages 50-64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18-49 years and 50-64 years; all P < .01). Among privately insured survivors, having a high-deductible health plan without a health savings account was found to be associated with greater hardship compared with having low-deductible insurance.RESULTSCompared with those without a cancer history, cancer survivors were more likely to report any material (ages 18-49 years: 43.4% vs 30.1%; ages 50-64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18-49 years: 53.5% vs 47.1%), and behavioral (ages 18-49 years: 30.6% vs 21.8%; and ages 50-64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18-49 years and 50-64 years; all P < .01). Among privately insured survivors, having a high-deductible health plan without a health savings account was found to be associated with greater hardship compared with having low-deductible insurance.Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design.CONCLUSIONSYounger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design. Cancer survivors encounter greater medical financial hardship compared with individuals without a cancer history in material, psychological, and behavioral domains, with the greatest hardships observed in younger populations. Among privately insured survivors, having a high‐deductible health plan without a health savings account is associated with greater medical financial hardship. The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States. The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18-49 years [1424 survivors], ages 50-64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18-64 years [66,951 individuals], ages 50-64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18-64 years only). Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18-49 years: 43.4% vs 30.1%; ages 50-64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18-49 years: 53.5% vs 47.1%), and behavioral (ages 18-49 years: 30.6% vs 21.8%; and ages 50-64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18-49 years and 50-64 years; all P < .01). Among privately insured survivors, having a high-deductible health plan without a health savings account was found to be associated with greater hardship compared with having low-deductible insurance. Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design. BackgroundThe current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.MethodsThe 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18‐49 years [1424 survivors], ages 50‐64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18‐64 years [66,951 individuals], ages 50‐64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18‐64 years only).ResultsCompared with those without a cancer history, cancer survivors were more likely to report any material (ages 18‐49 years: 43.4% vs 30.1%; ages 50‐64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18‐49 years: 53.5% vs 47.1%), and behavioral (ages 18‐49 years: 30.6% vs 21.8%; and ages 50‐64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18‐49 years and 50‐64 years; all P < .01). Among privately insured survivors, having a high‐deductible health plan without a health savings account was found to be associated with greater hardship compared with having low‐deductible insurance.ConclusionsYounger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design. |
| Author | Jemal, Ahmedin Guy, Gery P. Han, Xuesong Li, Chunyu Banegas, Matthew P. Ekwueme, Donatus U. Davidoff, Amy J. Yabroff, K. Robin Zheng, Zhiyuan |
| Author_xml | – sequence: 1 givenname: Zhiyuan orcidid: 0000-0002-7665-3564 surname: Zheng fullname: Zheng, Zhiyuan email: jason.zheng@cancer.org organization: Surveillance and Health Services Research Program, American Cancer Society – sequence: 2 givenname: Ahmedin orcidid: 0000-0002-0000-4111 surname: Jemal fullname: Jemal, Ahmedin organization: Surveillance and Health Services Research Program, American Cancer Society – sequence: 3 givenname: Xuesong surname: Han fullname: Han, Xuesong organization: Surveillance and Health Services Research Program, American Cancer Society – sequence: 4 givenname: Gery P. surname: Guy fullname: Guy, Gery P. organization: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention – sequence: 5 givenname: Chunyu surname: Li fullname: Li, Chunyu organization: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention – sequence: 6 givenname: Amy J. surname: Davidoff fullname: Davidoff, Amy J. organization: Yale School of Public Health – sequence: 7 givenname: Matthew P. surname: Banegas fullname: Banegas, Matthew P. organization: The Center for Health Research, Kaiser Permanente – sequence: 8 givenname: Donatus U. surname: Ekwueme fullname: Ekwueme, Donatus U. organization: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention – sequence: 9 givenname: K. Robin surname: Yabroff fullname: Yabroff, K. Robin organization: Surveillance and Health Services Research Program, American Cancer Society |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30663039$$D View this record in MEDLINE/PubMed |
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The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.
Methods
The 2013... Cancer survivors encounter greater medical financial hardship compared with individuals without a cancer history in material, psychological, and behavioral... The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States. The 2013 to 2016 National... BackgroundThe current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.MethodsThe 2013 to... The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.BACKGROUNDThe current study... |
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| SubjectTerms | Adult Age Age Factors Aged Aged, 80 and over benefit design Cancer cancer survivors Cancer Survivors - statistics & numerical data Cost of Illness Cross-Sectional Studies Domains Female Health Health Expenditures - statistics & numerical data health insurance Health savings accounts Humans Insurance Insurance, Health - economics Logistic Models Male medical financial hardship Medical materials Middle Aged Oncology Outcome Assessment, Health Care Retrospective Studies Risk Assessment Socioeconomic Factors Survival Underwriting United States Young Adult |
| Title | Medical financial hardship among cancer survivors in the United States |
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