J. Frank Wharam (
Fang Zhang is an assistant professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.
Health Aff (Millwood). 2019 Mar;38(3):408-415. doi: 10.1377/hlthaff.2018.05026.
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.
高免赔额健康计划 (HDHPs) 对弱势群体乳腺癌诊断和治疗的影响尚不清楚。我们研究了一组女性的首次乳腺癌诊断检测、诊断和化疗时间，这些女性的雇主在 2004 年至 2014 年间将其保险范围从低免赔额（500 美元或以下）的健康计划转为高免赔额（1000 美元或以上）的计划。主要的亚组包括连续一年和最多四年在低免赔额计划中参保的 54403 名低收入女性和 76776 名高收入女性。匹配的对照组具有同期的低免赔额参保记录。在 HDHPs 中的低收入女性首次乳房成像的时间相对延迟了 1.6 个月，首次活检的时间延迟了 2.7 个月，早期乳腺癌诊断的时间延迟了 6.6 个月，首次化疗的时间延迟了 8.7 个月。高收入 HDHP 成员的延迟时间较短，但与低收入成员相比没有显著差异。居住在大都市、非大都市、以白人为主和以非白人为主地区的 HDHP 成员也经历了延迟的乳腺癌护理。可能需要制定政策来减少乳腺癌护理的自付支出义务。
