Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA.
Center for Health Research, Kaiser Permanente, Portland, OR.
J Oncol Pract. 2019 Nov;15(11):e957-e968. doi: 10.1200/JOP.18.00699. Epub 2019 Aug 8.
To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization.
The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the associations among HDHP/health savings account (HSA) status, delayed/forgone care for financial reasons, and hospital emergency department (ED) visits among cancer survivors compared with individuals without a cancer history.
Among cancer survivors, HDHPs with or without HSA (8.9% and 13.9%, respectively; both < .05) were associated with more delayed/forgone care compared with low-deductible health plans (LDHPs) (7.9%). HSA enrollment was associated with less delayed/forgone care among HDHP cancer survivors ( < .05). ED visits were similar by insurance type. Among individuals without a cancer history, HDHP with or without HSA (9.5% and 10.8%, respectively; both < .05) were both associated with more delayed/forgone care compared with LDHPs (5.9%). HSA enrollment also was associated with less delayed/forgone care among HDHP enrollees without a cancer history. A small difference in ED visits was observed between HDHPs without HSA (15.3%) and LDHPs (14.1%; < .05) or HDHPs with HSA (13.4%; < .05) among individuals without a cancer history.
HDHP enrollment and HSA status affect access to care and hospital ED visits similarly by cancer history. HDHP enrollment may serve as a barrier to access to care among cancer survivors, although HSA enrollment coupled with an HDHP may mitigate the impact on access. HDHPs and HSA status were not associated with ED visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce ED visits among privately insured cancer survivors.
研究高免赔额健康计划（HDHP）参保、癌症存活者、获得医疗服务和利用情况之间的关联。
利用 2010 年至 2017 年全国健康访谈调查数据，确定 18 至 64 岁的私人保险成年人（癌症存活者，n=4321；无癌症病史者，n=95316）。采用多变量逻辑回归评估与无癌症病史者相比，癌症存活者中 HDHP/健康储蓄账户（HSA）状态、因财务原因延迟/放弃治疗以及到医院急诊部（ED）就诊的关联。
在癌症存活者中，HDHP 有或无 HSA（分别为 8.9%和 13.9%；均<0.05）比低免赔额健康计划（LDHP）更易导致延迟/放弃治疗（7.9%）。HSA 参保与 HDHP 癌症存活者延迟/放弃治疗减少有关（<0.05）。按保险类型，ED 就诊率相似。在无癌症病史者中，HDHP 有或无 HSA（分别为 9.5%和 10.8%；均<0.05）比 LDHPs 更易导致延迟/放弃治疗（5.9%）。HSA 参保也与无癌症病史者中 HDHP 参保者延迟/放弃治疗减少有关。无 HSA 的 HDHP（15.3%）与 LDHPs（14.1%；<0.05）或有 HSA 的 HDHP（13.4%；<0.05）之间，以及无 HSA 的 HDHP 与 LDHPs 之间，ED 就诊率存在微小差异。
癌症病史对 HDHP 参保和 HSA 状态对获得医疗服务和到 ED 就诊的影响相似。HDHP 参保可能成为癌症存活者获得医疗服务的障碍，尽管 HDHP 参保加上 HSA 可能减轻对获得医疗服务的影响。HDHP 和 HSA 状态与癌症存活者的 ED 就诊率无关。可能需要改善护理协调工作，以减少私人保险癌症存活者的 ED 就诊率。
