Health Insurance Literacy and Financial Hardship in Women Living With Metastatic Breast Cancer

Abstract

PURPOSE: In patients with metastatic breast cancer (MBC), low health insurance literacy may be associated with adverse material conditions, psychological response, and coping behaviors because of financial hardship (FH). This study explored the relationship between health insurance literacy and FH in women with MBC. METHODS: This cross-sectional study used data collected from 84 women receiving MBC treatment at 2 southeastern cancer centers. Low health insurance literacy was defined as not knowing premium or deductible costs. FH was defined by lifestyle changes as a result of medical expenses, financial toxicity, and medical care modifications attributable to cost. Mean differences were calculated using Cramer’s V. Associations between health insurance literacy and FH were estimated with adjusted linear models. RESULTS: Half of the surveyed patients had low health insurance literacy, 26% were underinsured, 45% had private insurance, 39% had Medicare, and 15% had Medicaid. Patients with low health insurance literacy more often reported borrowing money (19% v 4%; V = 0.35); an inability to pay for basic necessities like food, heat, or rent (10% v 4%; V = 0.18); and skipping a procedure (8% v 1%; V = 0.21), medical test (7% v 0%; V = 0.30), or treatment (4% v 0%; V = 0.20) compared with patients with high health insurance literacy. Median Comprehensive Score for Financial Toxicity was 23 (interquartile range, 17-29). In adjusted models, health insurance literacy was not associated with financial toxicity. CONCLUSION: Low health insurance literacy was common in women receiving MBC treatment. Additional research to increase health insurance literacy could lessen undesirable material FH and unnecessary behavioral FH associated with cancer-related care.

Association of Health Insurance Literacy With Financial Hardship in Patients With Cancer

“…A low level of health insurance literacy has been found to be associated with financial hardship, although there is scant information that financial literacy may alter this association. 9 , 11 , 12 The present study adds to this evidence by highlighting that the material and behavioral (not the psychological) hardship domains are the ones affected by health insurance literacy. We also found that health insurance literacy no longer had a significant association with financial hardship when financial literacy was included in the primary model.…”

“… 8 Several studies have found an association between financial hardship, especially behavioral hardship or avoidance of care, and a lower health insurance literacy level. 9 , 10 , 11 , 12 Health insurance literacy is defined as “the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own financial and health circumstances, and use the plan once enrolled.” 13 To our knowledge, previous studies have not examined the role of financial literacy, a broader concept that includes skills and behaviors for making well-informed financial decisions, in the association between health insurance literacy and financial hardship. 14 , 15 Patients’ financial knowledge can help them devise strategies to manage medical expenses amid other financial pressures.…”

The association of health insurance literacy and numeracy with financial toxicity and hardships among colorectal cancer survivors

“…In a national sample of breast cancer survivors, Zhao et al found that survivors with HIL problems were more likely to report experiencing material and psychological financial hardship when compared to those not experiencing HIL issues [42]. In another study, metastatic breast cancer patients with low HIL were more likely to report having to borrow money, being unable to pay for basic needs, and forgoing medical tests, procedures, and treatment compared to patients with high HIL [43]. Evidence supports the need for continued investigation on the impact of HIL and other cost-related health literacy measures on mitigating the experiences and impact of FT among cancer survivors [44].…”

Time to add screening for financial hardship as a quality measure?

“…We propose the development of a new, standardized financial hardship screening tool, along with a compendium of local, state, and national resources, that fits within clinical workflows in practices ranging from academic medical centers to community‐based practices. Multiple domains for such an instrument can be considered, including: 1) adequacy of insurance coverage, 2) whether insurance coverage depends on the employment of the patient or a caregiver and vulnerability to loss of coverage, 3) health insurance and financial literacy of the patient and caregiver, 50,51 4) out‐of‐pocket expenses for copays, coinsurance, and deductibles as well as other medical costs, 5) out‐of‐pocket expenses for nonmedical services (eg, transportation, child care, home care, lodging, parking), and 6) impact on employment (eg, modification of work schedule, long‐term impact on ability to perform a job, work loss). Ultimately, the domains chosen should be those agreed upon by key stakeholders who experience and bear the financial burdens associated with cancer and its treatment.…”