Administrative Burden Associated with Cost-Related Delays in Care in U.S. Cancer Patients

Abstract

Purpose: U.S. cancer patients engage in a range of administrative tasks to pay for their healthcare (e.g., estimating costs, negotiating with insurers, and making sense of bills). This study investigates the relationship between payment tasks and timely access to cancer care. Methods: We administered a web-based survey to 510 cancer patients and survivors, stratified by cancer type and geographic region, to assess their financial and insurance concerns and experiences. Logistic regression was used to determine if there was an independent relationship between number of administrative payment tasks and odds of cost-related delay/nonadherence. Results: Younger patients (£ 44 years) reported more payment tasks and cost-related delays/nonadherence than older patients (³ 55 years); African American patients reported more payment tasks and cost-related delays/nonadherence than white patients. After accounting for age, race/ethnicity, education, and estimated out-of-pocket costs, patients who reported engaging in more tasks had greater odds of delaying or forgoing care due to cost (OR = 1.53, 95% CI: 1.26, 1.85). Conclusion: Payment tasks increased the odds of cost-related delays and nonadherence by over 50%, taking the form of delayed or skipped doctor appointments, tests and bloodwork, and prescription fulfillment. Younger patients and those identifying as African American were more likely to engage in payment tasks and delay or forgo care due to cost. Administrative burdens can disrupt access to care and traditionally underserved patient populations are disproportionately exposed to these hardships. Reducing the administrative complexity of healthcare through universal, human-centered design could reduce burdens and increase access.

The Patient Experience of Prior Authorization for Cancer Care

“…To our knowledge, this study is the first to ask oncology patients about their experience with PA. Understanding the patient perspective is a vital component of efforts to refine the PA process, given that patients (and their families) are ultimately financially responsible for resultant medical bills and often must take on the administrative burdens of PA while simultaneously managing the physical and psychosocial effects of their disease and treatment . Prior studies have suggested that additional burdens are associated with delayed or forgone care and are more likely to affect those who are already at risk for compromised or fractured care, including Black or African American, disabled, female, and low-income patients . Research also shows that PA may place disproportionate limitations to access on vulnerable populations, patients of Asian descent, and those with Medicare Advantage plans .…”

“… 19 Prior studies have suggested that additional burdens are associated with delayed or forgone care and are more likely to affect those who are already at risk for compromised or fractured care, including Black or African American, disabled, female, and low-income patients. 20 , 21 Research also shows that PA may place disproportionate limitations to access on vulnerable populations, patients of Asian descent, and those with Medicare Advantage plans. 22 , 23 , 24 Dealing with PA issues adds an extra layer of stress, which is known to increase anxiety and can worsen treatment-related and disease-related symptoms and adverse effects.…”