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Health Aff (Millwood). 2019 Mar;38(3):408-415. doi: 10.1377/hlthaff.2018.05026.

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

Author information

1
J. Frank Wharam ( jwharam@post.harvard.edu ) is an associate professor in and director of the Division of Health Policy and Insurance Research, Department of Population Medicine, at Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts.
2
Fang Zhang is an assistant professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.
3
Jamie Wallace is a project manager in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.
4
Christine Lu is an associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.
5
Craig Earle is a professor of medicine at IC/ES, in Toronto, Ontario.
6
Stephen B. Soumerai is a professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.
7
Larissa Nekhlyudov is an associate professor of medical oncology at the Dana-Farber Cancer Institute, in Boston.
8
Dennis Ross-Degnan is an associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.

Abstract

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.

PMID:
30830830
DOI:
10.1377/hlthaff.2018.05026

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