Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.

Journal Article (Journal Article)

The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among a group of women whose employers switched their insurance coverage from health plans with low deductibles ($500 or less) to plans with high deductibles ($1,000 or more) between 2004 and 2014. Primary subgroups of interest comprised 54,403 low-income and 76,776 high-income women continuously enrolled in low-deductible plans for a year and then up to four years in HDHPs. Matched controls had contemporaneous low-deductible enrollment. Low-income women in HDHPs experienced relative delays of 1.6 months to first breast imaging, 2.7 months to first biopsy, 6.6 months to incident early-stage breast cancer diagnosis, and 8.7 months to first chemotherapy. High-income HDHP members had shorter delays that did not differ significantly from those of their low-income counterparts. HDHP members living in metropolitan, nonmetropolitan, predominantly white, and predominantly nonwhite areas also experienced delayed breast cancer care. Policies may be needed to reduce out-of-pocket spending obligations for breast cancer care.

Full Text

Duke Authors

Cited Authors

  • Wharam, JF; Zhang, F; Wallace, J; Lu, C; Earle, C; Soumerai, SB; Nekhlyudov, L; Ross-Degnan, D

Published Date

  • March 2019

Published In

Volume / Issue

  • 38 / 3

Start / End Page

  • 408 - 415

PubMed ID

  • 30830830

Pubmed Central ID

  • PMC7268048

Electronic International Standard Serial Number (EISSN)

  • 1544-5208

Digital Object Identifier (DOI)

  • 10.1377/hlthaff.2018.05026


  • eng

Conference Location

  • United States