Cancer patients are at much greater risk of
bankruptcy than people without cancer, according to a large new study. And
while the new health care law promises insurance coverage to more than 30
million Americans who lack it now, the high cost of cancer care can push many
patients, especially younger women, into financial trouble, experts say.
“We need to look into why this happening and see if
there is something we as a society can do to reduce that risk,” says Dr. Scott
Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research in
Seattle and lead author of the study published Wednesday in the journal Health
Affairs.
Ramsey and his colleagues matched 197,840 adults
from a western Washington cancer registry with an equal
number of cancer-free adults by age, zip code and sex. They then determined who
had filed for bankruptcy, using court records.
The researchers found that 4,408 of those diagnosed
with cancer between 1995 and 2009 had filed for bankruptcy, compared to 2,291
of those without cancer. Overall, cancer patients were 2.5 times as likely as
others to file for bankruptcy.
Non-white females were the most likely to file,
while patients 65 or older were the least likely -- possibly because they were
covered by Medicare and eligible for Social Security.
Bankruptcy rates among the younger groups were up
to 10 times that of the older patients. “People who have fewer assets, less
income and less generous insurance because of entry level jobs or no insurance
are more vulnerable to severe financial distress,” Ramsey says.
The highest rates of bankruptcy were among those
with thyroid cancer, which mostly affects younger women. The lowest were in men
with prostate cancer, which typically strikes at an older age.
“They used an ingenious way of getting this
information,” says Dr. David Himmelstein, an internist and professor of public
health at the City University of New York. And though the researchers don’t
have information on the cancer patients’ insurance coverage, “previous studies
tell us that about three-quarters of people who say that illness was a major
factor in their bankruptcy had private health insurance, at least when they
first got sick,” Himmelstein says.
That rings true for Janet Literski, 57, who had
purchased health insurance as an independent contractor working in sales. When
she was diagnosed with non-Hodgkin’s lymphoma in 2008 Literski discovered her
insurance covered only part of her surgical costs and none of her diagnostic
tests. Then there were co-payments and deductibles. By the time she was
diagnosed with pancreatic cancer two years later, she was about $150,000 in
medical debt.
In 2011, no longer able to work, Literski and her
disabled husband filed for bankruptcy. “It was a gut wrenching decision because
you feel like a personal failure, and that makes me angry because I had tried
to do everything right,” Literski says. “I had health insurance, I was
working.”
Literski is now covered by Medicaid and receives
disability payments and though she hasn’t been told she’s in remission, she
says she is “healthy enough.”
Ramsey says cancer centers need to do a better job
of assessing each patient’s financial status, offering credit counseling, and
managing patient care.
Steven Wieckowski, a financial counselor with the
national nonprofit GreenPath Debt Solutions, advises newly diagnosed cancer
patients to assess how the diagnosis might impact their income; to review their
health insurance policy coverages; to determine whether they’re signed up for a
disability plan at work; to prioritize their bills, putting housing, utilities,
food, car payments and child care at the top of the list; and to reach out to
credit card companies and the holders of student loans to ask for deferral.
“When cancer strikes, a lot of folks feel so out of
control,” Wieckowski says. These steps can put people back into control of this
portion of their life.”
Ramsey believes the 2010 Patient Protection and
Affordable Care Act, which will extend health insurance coverage to more than
30 million Americans, could reduce bankruptcy rates.
But Himmelstein, who examined Massachusetts
bankruptcy rates two years after the state implemented a health reform law
similar to the federal law, isn’t hopeful.
“We found little or no impact, basically because
the insurance coverage people got was so skimpy that it offered inadequate
financial protection,” he says.
Source: NBC News Health
