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Prior health insurance coverage disruptions linked to issues with healthcare access for cancer patients

About 260,000 currently insured cancer survivors ages 18-64 had coverage disruptions in 2018.

Jeff Lagasse, Associate Editor

Health insurance coverage disruptions in the prior year led to issues with healthcare access and affordability for currently insured cancer survivors, according to an American Cancer Society study published in Cancer Epidemiology, Biomarkers and Prevention.

Little is known about the effects of health insurance coverage disruptions on access to healthcare among cancer survivors. To learn more, investigators led by Jingxuan Zhao, MPH, estimated the prevalence of health insurance coverage disruptions and evaluated their associations with access to healthcare and affordability among cancer survivors aged 18-64 in the U.S. using national data from 2011 to 2018. 

Health insurance coverage disruption was measured as self-reports of any time in the prior year without coverage.


They found that about 260,000 currently insured cancer survivors ages 18-64 had coverage disruptions in 2018. 

Among privately and publicly insured survivors, those with coverage disruptions were less likely to report all preventive services use, including blood pressure checks, blood cholesterol checks, flu shots and dental care, compared to those continuously insured (16.9% vs. 36.2%; 14.6% vs. 25.3%, respectively). 

Currently insured survivors with private or public coverage were also more likely to report any problems with care affordability (55.0% vs. 17.7%; 71.1% vs. 38.4%, respectively) and any cost-related medication nonadherence (39.4% vs. 10.1%; 36.5% vs. 16.3%, respectively), such as skipping, taking less, and delaying medication to save money, compared to those continuously insured.

What makes the findings particularly relevant is widespread unemployment and the potential loss of employer-based private health insurance coverage due the COVID-19 pandemic, which can also cause disruptions. The rate of such disruptions is likely to rise among cancer survivors, adversely affecting affordability and access to care.


Access isn't the only potential hardship faced by cancer survivors and current cancer patients. Checking what hospitals charge for a standard radiation treatment for prostate cancer can be complicated and burdensome, a January report in JAMA Oncology found.

At issue is whether a federal rule that requires hospitals to publicly list standard charges for services and procedures – the foundation of price transparency – would enable people to compare prices for care provided at National Cancer Institute-designated cancer centers.

The researchers searched the websites of 63 NCI-designated cancer centers for the listed cost for simple intensity-modulated radiation therapy for prostate cancer, and discovered the information was not consistent – or was missing altogether.

While 52 centers, or 83%, published the cost, three did not list a cost for a simple IMRT, and eight did not publish costs for any procedure.

The published costs also varied greatly, and were listed for a single procedure and not the entire course of care. The average price was 10 times the Medicare reimbursement rate. There also wasn't any information provided on discounted rates that private insurance companies may have negotiated.

The lack of common terminology, unbundled cost reporting, the wide range in pricing from center to center, and the listing of non-negotiated rates limit the information's value, especially when a person is trying to estimate or compare the cost of care, the authors found.

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