Health Savings Accounts Linked to Care Access in Cancer Survivors

Whether a cancer survivor had a health savings account (HSA) as part of their high-deductible health plan was linked to access to care, according to the results of a study recently published in the Journal of Oncology Practice.

“This was an important study because of the increasing role of high-deductible health plans in our insurance system,” said Lindsay Sabik, PhD, associate professor, health policy and management, University of Pittsburgh Graduate School of Public Health, during an interview with Cancer Network. “As [high-deductible health plans] become more widespread, understanding their impacts for different patient populations will be important.”

Study researchers used data from the National Health Interview which reports on a broad range of health topics such as insurance and chronic pain in cancer survivors. From the 2010 to 2017 surveys, researchers selected individuals with or without a cancer history who had private insurance and were between the ages of 18 and 64 years.

A total of 4,321 people with a history of cancer and 95,316 without a history of cancer were identified and included in the analysis. Individuals were further stratified by their health plan type: low-deductible health plan, high-deductible health plan with an HSA, and high-deductible health plan without an HSA.

High-deductible health plans were defined as annual deductibles exceeding the following: $1,200 per person ($2,400 per family) for 2010, 2011, and 2012; $1,250 per person ($2,500 per family) for 2013 and 2014; and $1,300 per person ($2,600 per family) for 2015, 2016, and 2017. Low-deductible health plans were defined as annual deductibles below the aforementioned cutoffs.

Significantly more cancer survivors in high-deductible health plans without an HSA delayed or skipped care compared with those in low-deductible health plans (13.9% vs 7.6%; P <0.001). In contrast, the proportion of cancer survivors who delayed or skipped care was similar between those in high-deductible health plans with an HSA and those in low-deductible health plans (8.9% vs 7.6%; P=0.343), indicating that having an HSA is linked to access to care.

The analysis also found that cancer survivors with a lower income (ie, less than 400% of the federal poverty limit) had significantly more delayed or skipped care if they had a low-deductible health plan (14.3% vs 5.4%; P <0.001) or high-deductible health plan without an HSA (21.3% vs 14.0%; P=0.014) compared with cancer survivors with a higher income. These lower-income cancer survivors also had more trips to the emergency department if they had a high-deductible health plan without an HSA compared with higher-income cancer survivors (25.9% vs 19.1%; P=0.034).

“For cancer survivors with a lower income, the likelihood of delaying or forgoing care for those high-deductible health plan enrollees without an HSA was particularly high-at over 20%,” said Sabik. “Even though we know from other studies that lower-income patients face more barriers to care, the fact that this highlighted that gap between those in high-deductible health plans without an HSA and (plans) either with an HSA or in a low-deductible plan was an interesting and new contribution.”

One limitation of the study is high-deductible health plans are just “one piece” of the overall cost sharing that's required of patients, Sabik said. The analysis does not take into account coinsurance, out-of-pocket maximums, or the variability within high-deductible health plans. For example, some patients may have deductibles of $2,000 while others have deductibles of $6,000.

“This study wasn’t able to capture that wide variation in the size of the deductible,” said Sabik.