High-Deductible Health Plans and Mortality Among Cancer Survivors

Area of Science:

• Health Economics
• Oncology
• Public Health

Background:

• High-deductible health plans (HDHPs) are increasingly common, offering lower premiums but higher out-of-pocket costs.
• Previous research indicates HDHPs are associated with reduced healthcare utilization among cancer survivors.
• The impact of HDHPs on cancer-specific outcomes remains unclear.

Purpose of the Study:

• To investigate the association between HDHP status and survival (overall and cancer-specific) in cancer survivors and individuals without a cancer history.
• To determine if financial barriers mediate the relationship between HDHP status and survival.

Main Methods:

• Cross-sectional study using data from the National Health Interview Survey (2011-2018).
• Included US adults aged 18-84.
• Analyzed overall survival (OS) and cancer-specific survival (CSS), adjusting for multiple covariates.

Main Results:

• HDHP status was associated with worse OS (HR, 1.46) and CSS (HR, 1.34) in cancer survivors.
• No significant association between HDHP status and mortality was found in adults without a cancer history (P for interaction = .001).
• Financial barriers mediated 30%-70% of the association between HDHP status and survival in cancer survivors.

Conclusions:

• HDHPs are linked to poorer survival outcomes for cancer survivors.
• The findings suggest that financial barriers associated with HDHPs may negatively impact necessary care and worsen cancer outcomes.
• HDHPs do not appear to affect mortality rates in the general adult population without a history of cancer.