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Health insurance coverage, care accessibility and affordability for adult survivors of childhood cancer: a cross-sectional study of a nationally representative database

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Abstract

Purpose

We describe national patterns of health insurance coverage and care accessibility and affordability in a national sample of adult childhood cancer survivors (CCS) compared to adults without cancer.

Methods

Using data from the 2010–2014 National Health Interview Survey (NHIS), we selected a sample of all CCS age 21 to 65 years old and a 1:3 matched sample of controls without a history of cancer. We examined insurance coverage, care accessibility and affordability in CCS and controls. We tested for differences in the groups in bivariate analyses and multivariable logistic regression models.

Results

Of all respondents age 21–65 in the full NHIS sample, 443 (0.35 %) were CCS. Fewer CCS were insured (76.4 %) compared to controls (81.4 %, p = 0.067). Significantly more CCS reported delaying medical care (24.7 vs 13.0 %), needing but not getting medical care in the previous 12 months (20.0 vs 10.0 %), and having trouble paying medical bills (40.3 vs 19.7 %) compared to controls (p < 0.0001 for all). More CCS reported trouble with care affordability in the previous 12 months compared to controls on six categories of care and for a combined measure of affordability (p < 0.0001 for composite of all). Adjusted analyses demonstrated that these differences comparing CCS to controls remained significant.

Conclusions

CCS report problems with health care accessibility and affordability. These analyses support the development of policies to assure that CCS have access to affordable services.

Implications for Cancer Survivors

Efforts to improve access to high-quality and affordable insurance for CCS may help reduce the gaps in getting medical care and problems with affordability. Health care providers should be aware that such problems exist and should discuss affordability and ability to obtain care with patients.

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Acknowledgments

This project was funded by a grant from the Lance Armstrong Foundation.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Massachusetts General Hospital (MGH), and Harvard Medical School (HMS), 125 Nashua Street, Suite 860, Boston, MA, 01224, USA

    Karen A. Kuhlthau

  2. Clinical Fellow in Oncology, MGH Cancer Center, Yawkey 10B, Boston, MA, 02114, USA

    Ryan D. Nipp

  3. MGH Biostatistics Center, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA

    Amy Shui

  4. Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue Room 924, New York, NY, 10032, USA

    Sean Srichankij

  5. Department of Pediatric Hematology/Oncology, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4145, Salt Lake City, UT, 84112, USA

    Anne C. Kirchhoff

  6. HMS and Harvard Pilgrim Health Care Institute, Department of Population Medicine, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA

    Alison A. Galbraith

  7. Department of Psychiatry, MGH and HMS, 50 Staniford Street, Room 907, Boston, MA, 02114, USA

    Elyse R. Park

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  1. Karen A. Kuhlthau
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  2. Ryan D. Nipp
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  3. Amy Shui
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Corresponding author

Correspondence to Karen A. Kuhlthau.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study authors used publically available de-identified nationally representative data collected by the US Federal government and thus were not responsible for obtaining consent.

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Kuhlthau, K.A., Nipp, R.D., Shui, A. et al. Health insurance coverage, care accessibility and affordability for adult survivors of childhood cancer: a cross-sectional study of a nationally representative database. J Cancer Surviv 10, 964–971 (2016). https://doi.org/10.1007/s11764-016-0542-7

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  • DOI: https://doi.org/10.1007/s11764-016-0542-7

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