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Original Investigation
June 2018

Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act

Author Affiliations
  • 1Massachusetts General Hospital and Harvard Medical School, Boston
  • 2Massachusetts General Hospital Cancer Center, Boston
  • 3Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City
JAMA Oncol. 2018;4(6):791-797. doi:10.1001/jamaoncol.2018.0097
Key Points

Questions  What are the issues with health care access and affordability for cancer survivors compared with non–cancer-affected control respondents, and how did the proportion of survivors reporting these issues change over time?

Findings  In this population-based study of 30 364 participants using 2010 to 2016 data from the National Health Interview Survey, cancer survivors were more likely than control respondents to report delayed or forgone health care, and inability to afford medications and health care services. The proportion of cancer survivors reporting delayed or forgone care and inability to afford health care services significantly decreased during implementation of the Affordable Care Act (2010-2016).

Meaning  Despite recent improvements, cancer survivors continue to experience difficulties accessing and affording health care.

Abstract

Importance  Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking.

Objectives  To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act.

Design, Setting, and Participants  We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers.

Main Outcomes and Measures  We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties.

Results  Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not getting medical care also decreased each year (B = 0.35; P = .04). In addition, the proportion of cancer survivors who reported being unable to afford prescription medication decreased each year (B=0.66; P = .004) and the proportion of those unable to afford at least 1 of 6 services decreased each year (B = 0.51; P = .01).

Conclusions and Relevance  Despite higher rates of insurance coverage, cancer survivors reported greater difficulties accessing and affording health care compared with adults without cancer. Importantly, the proportion of survivors reporting these issues continued a downward trend throughout our observation period in the years following the implementation of the Affordable Care Act. Our findings suggest incremental improvement in health care access and affordability after recent health care reform and provide an important benchmark as additional changes are likely to occur in the coming years.

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