Study: Un­ex­pected costs add ex­tra bur­den to can­cer pa­tients, fam­i­lies

The Washington Times Daily - - NATION - BY LAURA KELLY

The shock of a can­cer di­ag­no­sis typ­i­cally leaves lit­tle room for pa­tients to worry about much else. But ris­ing and un­ex­pected costs of care add an ad­di­tional bur­den to pa­tients and their fam­i­lies al­ready hit with an un­ex­pected life change, ac­cord­ing to on­col­ogy re­search pub­lished Thurs­day.

Re­searchers at Duke Univer­sity Med­i­cal Cen­ter found that among a study of 300 can­cer pa­tients, more than one-third felt dis­tress in the face of outof-pocket med­i­cal ex­penses re­lated to their treat­ment.

The study was pub­lished as a re­search let­ter in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion On­col­ogy.

The pa­tients in the study all had health in­sur­ance, but the fi­nan­cial bur­den came from be­ing un­der­in­sured, which re­quired some to de­vote one-third of their pay­checks to med­i­cal bills.

“While the [Af­ford­able Care Act] has done a tremen­dous amount to in­crease ac­cess to health in­sur­ance, it’s lim­ited in its ef­fect to de­crease cost of care plans that were in­tro­duced,” said Dr. Yousuf Za­far, one of the co-au­thors of the re­search let­ter.

In­creas­ing drug prices from phar­ma­ceu­ti­cal com­pa­nies, di­ag­nos­tic tests like CT scans and even doc­tor vis­its not cov­ered by in­sur­ance con­trib­ute to fi­nan­cial bur­dens of pa­tients. Other out-of-pocket costs in­di­rectly re­lated to care in­clude lost in­come from time off work, cost of travel to treat­ment cen­ters, lodg­ing and meals on the road, among oth­ers.

“A lot of peo­ple that get for­got­ten are those who are un­der­in­sured, and those are the fo­cus of this study,” said Dr. Za­far. “Th­ese are peo­ple who have in­sur­ance but still pay a large pro­por­tion — 10 to 30 per­cent of their in­come — for their can­cer treat­ment.”

Ac­cord­ing to the Na­tional Can­cer In­sti­tute, an es­ti­mated 1.7 mil­lion new can­cer di­ag­no­sis will be given in 2017 and about 600,920 peo­ple will die from a type of can­cer this year.

A 2013 study led by the In­sti­tute of Medicine (now the Na­tional Academy of Medicine) es­ti­mated that health care costs re­lated to can­cer will to­tal $173 bil­lion by 2020.

The Duke Univer­sity re­searchers rec­om­mend fi­nan­cial in­ter­ven­tion ef­forts to “im­prove pa­tient health care cost lit­er­acy” and fu­ture stud­ies should eval­u­ate the im­pact of such in­ter­ven­tions.

One of the rec­om­men­da­tions is to in­crease the fi­nan­cial lit­er­acy of pa­tients, with in­sur­ance com­pa­nies and hos­pi­tals pro­vid­ing re­sources.

“Of­ten­times, we get in­sur­ance and don’t re­ally want to think about it un­til we need it — by then it might be too late,” Dr. Za­far said.

How­ever, in­di­vid­u­als given a life-al­ter­ing can­cer di­ag­no­sis will have lit­tle pa­tience then to sit on the phone with a health in­sur­ance provider to re­view and un­der­stand all as­pects of their plan, costs and cov­er­age, he said.

“A lot more could be done, and it is un­fair for a pa­tient who is fac­ing a cat­a­strophic ill­ness to sit on the phone with their in­sur­ance com­pany to find out what’s cov­ered and not cov­ered,” Dr. Za­far said.

The Af­ford­able Care Act com­pelled in­sur­ance com­pa­nies to send out pam­phlets or ex­plain­ers out­lin­ing what is and isn’t cov­ered un­der that par­tic­u­lar health plan. Other ini­tia­tives by in­sur­ance com­pa­nies, Dr. Za­far noted, in­clude adding cal­cu­la­tors to on­line sites to bet­ter help pa­tients un­der­stand how many costs are adding up to their de­ductibles.

Physi­cians and hos­pi­tals also can rec­om­mend pa­tients to fi­nan­cial ser­vices or other com­mu­nity ef­forts that help off­set costs. Dr. Za­far and oth­ers are de­vel­op­ing an app that would help pro­vide pa­tients with fi­nan­cial ed­u­ca­tion, screen­ing pa­tients for fi­nan­cial dis­tress and link­ing them to as­sis­tance pro­grams.

“The idea of com­mu­ni­cat­ing about af­ford­abil­ity is re­ally im­por­tant,” Dr. Za­far said. “Pa­tients have un­der­stand­able con­cerns of talk­ing to their health care teams about costs but I think — if I as a physi­cian know about my pa­tients trou­bles sooner rather than later, I can get them to re­sources at the right time.”

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