Cancer Patients Paid $ 5.6 Billion Out-of-pocket Cancer Costs in 2018

October 26, 2020 -Cancer patients are paying increasingly higher out-of-pocket costs for treatment, and the American Cancer Society’s recent reportPayer-related costs are the most common factor in this financial burden.

“As the leading cause of death and illness in the United States, cancer not only has a tremendous impact on the health of patients and survivors, but also has a tremendous economic impact,” the report began. “There are more than 200 types of cancer, so there is no” universal “cancer treatment. Therefore, the cost of cancer treatment varies widely from patient to patient. However, there are some consistent factors that contribute to the overall cost of patient care. “

The report states that insurance types, premiums, deductions, out-of-pocket costs, joint insurance, out-of-pocket caps, in-network and off-network costs, and balance and surprise claims are the main causes of high patient costs. It is listed. -Out-of-pocket costs.

Treatment plans, geographic locations, and treatment settings, on the other hand, can all lead to very different invoices for different cancer patients.

There are also various overhead costs such as transportation, housing, income, cosmetics and long-term care.

read more: Key Payer Strategies for Improving Colorectal Cancer Preventive Care

For example, urban areas have five times as many oncologists as rural areas. Rural patients need to arrange and pay for more trips, especially on one-way commute, which is twice as long as the average commute time for cancer patients in urban and suburban areas.

“The coverage of insurance is important,” the report found. “In each scenario, patients paid a reasonable amount for their care, but would have paid a fairly high amount if they were not covered by insurance.”

Patients with health insurance sponsored by employers from large corporations had the lowest out-of-pocket medical costs. Their premiums and cost sharing were also relatively affordable, with lower maximum out-of-pocket costs and faster implementation.

Patients covered by small employers, high-deduction health plans, or personal health insurance market plans have higher out-of-pocket limits and deductions.

Medicare beneficiaries, including Medigap policyholders, pay higher premiums, but lower out-of-pocket and co-insurance. Beneficiaries without supplementary compensation were at a disadvantage and would have to pay more.

read more: Three Ways Payers Promote Population Health Care in Cancer Treatment

Patient who had Short-term limited-term health insurance Almost twice the deduction amount of other plan types. In addition, health insurance did not cover much of the cost, leaving the patient to bear the full cost.

For those who plan to not cover the cost of treatment, Medical debt..

In a case study, patients with lymphoma paid out-of-pocket health insurance costs from $ 6,446 for large employer-sponsored health insurance to $ 12,931 for personal health insurance market health insurance. All of these were plans that were compliant with the Affordable Care Act (ACA).

In contrast, for short-term, limited-time plans that do not require compliance with ACA standards, patients paid $ 51,660 at their own expense.

“Cancer patients are super-users of insurance benefits, and each patient in the out-of-pocket scenario quickly reached its maximum,” the report said. “At the maximum, patients no longer have to pay for eligible services in the network. This is an important protection for many private sector patients.”

read more: Cancer treatment costs about $ 150 billion nationwide

The report analyzed the cost of cancer, recognizing that cancer types and treatment plans primarily drive cost factors.

In four of the six cancer case studies, drug costs accounted for more than 60% of treatment costs. In three case studies, imaging tests contributed less than 10% to about 20% of the cost.

In a colon-rectal case study, hospital costs and surgery accounted for about 90% of patient spending. On the other hand, in the case of pancreatic cancer, these costs accounted for about 50% of the out-of-pocket treatment costs.

The study found that the use of biosimilars could reduce drug costs under certain conditions. For two years of breast cancer, branded drug patients cost more than $ 74,000, but biosimilars reduced this spending by 21%.

Other unexpected costs that may contribute to cancer spending include preventative screening.

“Almost all insurance plans need to cover specific prevention and cancer screening services at no cost to the patient,” the report said. “But some patients encounter loopholes in these requirements and get unexpected charges for services they thought were free.”

The report included some policy changes that helped make medical costs for cancer patients more manageable.

“The most important thing policy makers can do to help cancer patients bear the cost of cancer is to give everyone access to comprehensive and affordable health insurance,” the researchers said. Are writing.

The report found that insured cancer patients are twice as likely to receive preventive care services to detect cancer early, thereby reducing costs. Conversely, uninsured people are not screened and it is too late for cancer to be found, resulting in poor survival.

The recommendations of the second policy are based on the recommendations of the first by encouraging better preventive care services and screening processes. Precision medicine and care coordination It is an effective tool for detecting and treating cancer in the early stages of cancer development.Also, many payers are starting to send home test kits to risky members. Colorectal cancer..

Policy makers also need to focus on making health care more affordable, especially on reducing deductions, and making it more accessible by opposed to non-inclusive health care plans. There is.

The report also recommends that healthcare providers participate in programs such as the following to help patients more financially. Tumor treatment model Require price transparency of procedure costs.