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Cancer patients with high deductible health plans face significantly higher out-of-pocket costs that may be driving treatment decisions, a new study found.

 Wednesday morning, examined more than 134,000 cancer patients between 2008 and 2018.

High deductible health plans “offer poorer protection than traditional insurance against unexpected health care expenses,” the authors of the study wrote.

As cancer care grows more expensive, more research should be done to examine the consequences of people delaying or abandoning treatment as a result of higher enrollment in high deductible health plans.

“Overall, our findings support previous studies that patients with cancer are subject to high financial burdens that may be associated with their clinical decision-making,” the authors wrote.

This study differs from previous research on healthcare costs among cancer patients in one significant aspect, the authors said. They wrote that to the best of their knowledge, this is the first time researchers used actual claims data to compare out-of-pocket costs among a large group of cancer patients with private insurance. Previous studies relied on cost estimates or patients’ reporting their own expenses.

Nationwide, 61% of American adults are covered through private health insurance. High deductible health plans are gaining more prevalence. Among those with private insurance, 30% had high deductible plans in 2019, up from 4% in 2006, the authors noted.

With high deductible health plans, consumers typically pay lower premiums, but they also have to pay more costs on their own before the insurance company starts paying. Theoretically, high deductible health plans are supposed to spur consumers to make better decisions about their health.

In reality, consumers with those plans delay treatment or hold off on preventive measures to protect their health, such as cancer screenings, the authors wrote.

The study found cancer patients with high deductible plans paid much more out of their own pocket than those with traditional insurance plans. The findings were especially stark among those diagnosed with breast cancer.

One year after diagnosis, breast cancer patients with high deductible plans paid $1,975 out of their own pocket. Cancer patients in traditional plans paid $160, the study found.

In addition, colorectal cancer patients in high deductible plans paid $865 more than those in traditional insurance plans during the month of diagnosis. Those with lung cancer in high deductible plans paid $655 per month more than those in traditional plans during the month of diagnosis.

The study also examined differences in costs among consumers without cancer. Consumers with high deductible plans paid a median of $63 per month in out-of-pocket costs, while those in traditional plans paid $30 per month.

The researchers also compared out-of-pockets costs among cancer patients with high deductible plans and those without cancer in traditional insurance plans. The differences were striking: those with breast cancer paid $1,683 more, while colorectal cancer patients paid $1,420 more out of their own pocket.

Those paying more out of pocket in high deductible plans are potentially suffering significant financial consequences, the authors note. They point to previous surveys indicating a majority of Americans couldn’t cover $1,000 in unexpected costs with their savings accounts.

The authors said more research should be done to examine clinical outcomes for those in high deductible plans.

“Financially vulnerable patients and their families continue to face painful decisions about whether to undergo high-cost cancer treatment or to delay or forego care,” the authors wrote.

Researchers at Stanford University, the Department of Veterans Affairs, and the Mayo Clinic produced the study.

Articles

Patients with a variety of cancers spent much more money out of their own pocket than those in traditional plans. Some may be delaying treatment due to higher costs.

With High Deductible Health Plans, Cancer Patients are Paying More, Study Finds

For year, experts viewed contagious respiratory pathogens in a binary way.

There were viruses like influenza and mumps that were spread by relatively large droplets produced by coughing and sneezing that fell to the ground relatively quickly. Doctors, nurses, and other clinicians were advised to wear facemasks to block the droplets.

The other group of pathogens traveled aerosols, minute respiratory particles that people produce when they talk and breath. Aerosols tend to stay suspended in the air for much longer periods of times than droplets and travel much farther. Measles and tuberculosis have been held up as two exemplars of viruses that spread this way. Precautions against aerosols include N95 masks, negative-pressure rooms, ventilation and high-efficiency particulate air (HEPA) filters.

But in a review published earlier this month in the 

, M.D., M.P.H., a professor of population medicine at Harvard Medical School and an infectious disease expert, and his colleagues argue that division of droplet and aerosol transmission is misguided and needs to be retired.

Research into COVID-19 and the virus that causes it, SARS-CoV-2, has helped reshape the understanding of respiratory virus transmission, the review argues. People generate the full range of respiratory particles, not either droplets or aerosols. Droplets can stay aloft for long periods like aerosols and respiratory viruses are not picky about the size of particle that they hitch a ride in, although aerosols may account for most transmission, partly because people produce aerosols just by talking and breathing.

The governing factor of transmission, wrote Klompas and his colleagues, is governed by “infectious dose” — the amount of virus a person is exposed to. Infectious dose is product of time and exposure concentration, or how much virus is in the air, the review says. Poor ventilation can allow virus-laden aerosols to accumulate and increase the exposure concentration and, as a result, the infectious dose. Good ventilation, HEPA filters and ultraviolet disinfection can decrease the amount of virus floating in the air. Time is factor because the longer a person spends breathing in air that has contaminated aerosols, the greater the infectious dose.

“Source strength”— or much a virus an infected person is spewing into the air in respiratory particles — is another factor in the complicated question, the reviewers explained.

Klompas and his colleagues — Chanu Rhee, M.D., M.P.H., and Meghan Baker, M.D., Sc.D., who are at Harvard with Klompas; Donald Milton, M.D., Dr.Ph., of the University of Maryland School of Public Health; and Surbhi Leekha, MBBS, M.P.H., of the University of Maryland School of Medicine — discussed some of the implications of the current understanding of respiratory virus transmission for infection control policies and programs.

Here is a list of potential policy responses included in the A

Consider creating a uniform set of respiratory precautions for all respiratory pathogens rather than differentiating between airborne vs. droplet pathogens

Consider using higher-level respiratory protection (e.g., N95 respirators) in the the care of all patients with active respiratory viral infections

Allocate airborne-infection isolation rooms for pathogens historically associated with long-range transmission and for patients with high viral loads 

Reinforce minimum ventilation standards for nonclinical spaces

Consider using higher-level respiratory protection such as N95 respirators for all prolonged, face-to-face encounters when the community incidence of SARS-CoV-2 is high

Consider using upper-room or 222-nm ultraviolet air disinfection or HEPA filters to decrease transmission risk in inadequately ventilated spaces.

Consider retiring the concept of aerosol-generating procedures

Risk-stratify patients instead on the basis of viral load, severity of illness, or anticipated duration of an encounter and proximity to the respiratory tract,.

The traditional dividing line between transmission by droplets and smaller aerosols is incorrect, say the authors of a Annals of Internal Medicine review paper, and infection control measures need to reflect the new understanding that respiratory viruses spread in respiratory particles of all sizes and perhaps mainly in aerosols.

Ron Southwick

Articles

With High Deductible Health Plans, Cancer Patients are Paying More, Study Finds

It's Time to Rethink Respiratory Virus Transmission and How To Prevent It in Healthcare Settings