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Cancer survivors face significant hardships related to medical bills

Having a high deductible health plan without a health savings account was associated with greater hardship compared with low deductible insurance.

Jeff Lagasse, Associate Editor

Cancer survivors carry greater financial burdens related to medical debt payments and bills compared to those without a cancer history, with the greatest hardships in younger survivors, new research has found.

It was also discovered that among privately insured survivors, those who enrolled in high deductible health plans and did not have health savings accounts were particularly vulnerable to medical financial hardship.


Medical financial hardship can encompass three domains: material (such as problems paying medical bills); psychological (like worrying about paying medical bills); and behavioral (which might include forgoing or delaying care because of cost).

To examine these domains, the authors analyzed information from the 2013 to 2016 National Health Interview Survey, which included representative samples of 10,354 cancer survivors and 124,436 people without a cancer history.

Compared with those without a cancer history, cancer survivors were more likely to report  material hardship. In ages 18 to 49, this was a comparison of 43.4 percent versus 30.1 percent. In ages 50 to 64, the comparable rate was 32.8 percent versus 27.8 percent, and in ages 65 and older, 17.3 percent versus 14.7 percent.

Cancer survivors were also more likely to report psychological and behavioral hardship. In ages 18 to 49, with similar rates for older adults, 53.5 percent of cancer survivors versus 47.1 percent reported psychological hardship. More than 30 percent of cancer survivors aged 18 to 49 reported behavioral hardship versus 21.8 percent without a cancer history. The rates for ages 50 to 64 were 27.2 percent versus 23.4 percent, with similar rates for those aged 65 and older.

Among privately insured survivors, having a high deductible health plan without a health savings account was associated with greater hardship compared with low deductible insurance -- a finding that may have policy implications.


Cancer costs are on the rise, for patients and also for payers and providers. While cancer deaths have been declining since the early 1990s, costs have continued to increase, with more than $147 billion spent for cancer care in the U.S. in 2017.

Despite these rising costs, employers and health plans have been reticent to manage oncology care, and are also faced with keeping pace with technology and treatment advances.

Twitter: @JELagasse

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