Zheng Daniel J, Murphy-Banks Rachel, Rodday Angie Mae, Xiang Qingyan, Linendoll Nadine, Beauchemin Melissa, Ohlsen Timothy J D, Fleisher Emma, Miller Kimberly A, Freyer David R, Crosswell Howland E, Chan Randall Y, Roth Michael E, Parsons Susan K
Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
JCO Oncol Pract. 2025 Jun 16:OP2401075. doi: 10.1200/OP-24-01075.
To explore long-term young adult (YA) cancer survivors' experience with health insurance in a post-Affordable Care Act (ACA) era.
This was a mixed-methods analysis of insurance-related data collected from a cohort of English-speaking YA (currently age 18-39 years) blood cancer survivors, ≥3 years from diagnosis, recruited from six US hospitals as part of a financial navigation interventional study (ClinicalTrials.gov identifier: NCT05620979). Participants completed baseline questionnaires, with a subset participating in semistructured interviews after the 6-month study period. Summary statistics were reported for survey responses. Qualitative interviews were coded using directed content analysis.
A total of 130 long-term (median, 10 [IQR, 6-16] years from diagnosis) YA survivors were enrolled, and 45 participated in interviews. Among the total cohort, most (63%) had employer-based private insurance; 22% had public insurance through Medicaid. Eighteen percent reported seeking a new health insurance plan in the past year to afford survivorship care. Over a fifth (23%) reported not knowing how to seek help navigating insurance, while 30% reported delaying or forgoing survivorship care because of not understanding their insurance plan. Four themes emerged from the interviews: (1) Many YA survivors experience insurance churn (ie, moving between plans or between insured and uninsured status); (2) learning to navigate the insurance system is confusing and not straightforward; (3) interactions related to insurance coverage are time-consuming and stressful; and (4) insurance churn and/or out-of-pocket costs affect YAs' ability to receive optimal medical care.
Ongoing insurance-related challenges persist for YA cancer survivors in a contemporary post-ACA era. Although the ACA has provided essential coverage for many patients, ongoing issues include excessive insurance churn, lack of navigation resources, and the continued financial burden of out-of-pocket costs.
探讨《平价医疗法案》（ACA）时代之后，长期年轻成年（YA）癌症幸存者的医疗保险经历。
这是一项混合方法分析，数据来自一组年龄在18至39岁之间、讲英语的YA血癌幸存者，他们在确诊后至少3年，是从美国六家医院招募而来，作为一项财务导航干预研究的一部分（ClinicalTrials.gov标识符：NCT05620979）。参与者完成了基线调查问卷，其中一部分在6个月的研究期后参加了半结构化访谈。报告了调查回复的汇总统计数据。定性访谈采用定向内容分析法进行编码。
共招募了130名长期（确诊后中位数为10[四分位间距，6 - 16]年）YA幸存者，45人参加了访谈。在整个队列中，大多数（63%）拥有基于雇主的私人保险；22%通过医疗补助获得公共保险。18%的人报告在过去一年中寻求新的健康保险计划以支付生存护理费用。超过五分之一（23%）的人表示不知道如何寻求保险导航帮助，而30%的人报告因不了解保险计划而推迟或放弃生存护理。访谈中出现了四个主题：（1）许多YA幸存者经历保险变更（即从一个计划转到另一个计划，或在参保和未参保状态之间转换）；（2）学习在保险系统中导航令人困惑且并不简单直接；（3）与保险覆盖范围相关的互动既耗时又有压力；（4）保险变更和/或自付费用影响YA获得最佳医疗护理的能力。
在当代ACA后时代，YA癌症幸存者在保险相关方面仍面临持续挑战。尽管ACA为许多患者提供了基本保险，但持续存在的问题包括过度的保险变更、缺乏导航资源以及自付费用带来的持续经济负担。
