Health Insurance Literacy and Financial Toxicity in Adolescent and Young Adult Cancer Survivors

Empirical evidence examining the impact of health insurance literacy (HIL) on cancer-related financial toxicity (FT) among adolescent and young adults (AYAs) is limited. AYA cancer survivors experience greater levels of financial hardship due to sociodemographic and developmentally related factors. The purpose of this study was to examine the relationship between HIL and FT in this vulnerable population.

We used a cross-sectional design to survey 246 AYA cancer survivors (diagnosed between ages 15-39) through the Kentucky Cancer Registry (KCR). Survey data were collected on FT and HIL using the Health Insurance Literacy Scale (HILS) and Health Insurance Literacy Measure (HILM) subscales on behaviors related to choosing and using health insurance plans. Record-level KCR data included county of residence and race/ethnicity among other sociodemographic variables.

Two-thirds (67%) of participants indicated experiencing problems with understanding health insurance or medical bills. When adjusting for sociodemographic variables, those with inadequate HILS scores reporting higher (p = 0.002) FT scores than those with adequate HILS (b = 0.05, SE = 0.02). An inverse relationship (p = 0.042) was found between behaviors related to choosing health insurance plans and FT (b = -0.003, SE = 0.002). A significantly (p = 0.028) lower proportion of rural participants had adequate HILS scores (55%), compared to their urban counterparts (71%).

Our findings highlight the need for integrating HIL education and resources in FT interventions tailored to address the unique needs of geographically diverse AYA cancer survivors across the cancer continuum.