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Area of Science:

  • Health Services Research
  • Health Economics
  • Behavioral Health

Background:

  • High-cost medical treatments, such as cancer therapy, can create financial burdens impacting patient access to other necessary health services.
  • Deferring mental or behavioral health (M/BH) care can lead to increased preventable hospital utilization.
  • Understanding the interplay of income and out-of-pocket costs (OOPC) is crucial for cancer patients with comorbid M/BH conditions.

Purpose of the Study:

  • To investigate how patient income level and total out-of-pocket costs (OOPC) influence service utilization among insured adult cancer patients with a comorbid M/BH diagnosis.
  • To analyze the relationship between cost burden and the use of outpatient behavioral health services versus emergency department (ED) visits.

Main Methods:

  • Retrospective analysis of medical claims and administrative data from a large US commercial health plan (N=5,054) from July 2017 to June 2018.
  • Nonparametric tests to assess variations in utilization by income and OOPC deciles.
  • Negative binomial regression modeling to determine the independent effects of variables on outpatient behavioral and ED visit counts.

Main Results:

  • Significant variations in service utilization were observed based on income level and total OOPC.
  • Increased OOPC correlated with decreased outpatient behavioral care utilization (p <.000).
  • Lower-income patients (<$50,000/year) showed significantly fewer outpatient visits and more ED visits as OOPC increased, compared to average and higher-income groups (p <.000, p <.001).

Conclusions:

  • The combined effect of income level and OOPC (cost burden) may deter patients from accessing supportive behavioral care within commercial health plans.
  • The cumulative cost burden associated with cancer treatment can lead to underutilization of outpatient services and increased reliance on EDs, particularly for lower-income individuals.