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

Publication ,  Journal Article
Wharam, JF; Zhang, F; Wallace, J; Lu, C; Earle, C; Soumerai, SB; Nekhlyudov, L; Ross-Degnan, D
Published in: Health Aff (Millwood)
March 2019

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.

Duke Scholars

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Published In

Health Aff (Millwood)

DOI

EISSN

2694-233X

Publication Date

March 2019

Volume

38

Issue

3

Start / End Page

408 / 415

Location

United States

Related Subject Headings

  • Vulnerable Populations
  • Poverty
  • Middle Aged
  • Insurance, Health
  • Income
  • Humans
  • Health Policy & Services
  • Female
  • Delayed Diagnosis
  • Deductibles and Coinsurance
 

Citation

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Chicago
ICMJE
MLA
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Wharam, J. F., Zhang, F., Wallace, J., Lu, C., Earle, C., Soumerai, S. B., … Ross-Degnan, D. (2019). Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care. Health Aff (Millwood), 38(3), 408–415. https://doi.org/10.1377/hlthaff.2018.05026
Wharam, J Frank, Fang Zhang, Jamie Wallace, Christine Lu, Craig Earle, Stephen B. Soumerai, Larissa Nekhlyudov, and Dennis Ross-Degnan. “Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.Health Aff (Millwood) 38, no. 3 (March 2019): 408–15. https://doi.org/10.1377/hlthaff.2018.05026.
Wharam JF, Zhang F, Wallace J, Lu C, Earle C, Soumerai SB, et al. Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care. Health Aff (Millwood). 2019 Mar;38(3):408–15.
Wharam, J. Frank, et al. “Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.Health Aff (Millwood), vol. 38, no. 3, Mar. 2019, pp. 408–15. Pubmed, doi:10.1377/hlthaff.2018.05026.
Wharam JF, Zhang F, Wallace J, Lu C, Earle C, Soumerai SB, Nekhlyudov L, Ross-Degnan D. Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care. Health Aff (Millwood). 2019 Mar;38(3):408–415.

Published In

Health Aff (Millwood)

DOI

EISSN

2694-233X

Publication Date

March 2019

Volume

38

Issue

3

Start / End Page

408 / 415

Location

United States

Related Subject Headings

  • Vulnerable Populations
  • Poverty
  • Middle Aged
  • Insurance, Health
  • Income
  • Humans
  • Health Policy & Services
  • Female
  • Delayed Diagnosis
  • Deductibles and Coinsurance