Knowledge of Health Insurance, Financial Literacy Prevents Financial Crisis Among Cancer Patients

Financial difficulties among cancer patients have been shown to be a persistent issue even when they demonstrate increased access to health insurance and financial literacy, reports JAMA Network Open.

The study results were analyzed among 404 patients enrolled from the Mayo Clinic in Phoenix, Arizona (n = 299), from December 2019 to February 2020 and August to October 2020, and the University of Mississippi Medical Center (UMMC) in Jackson (n = 105 ) from September 2020 to February 2021. Ninety percent were female, 75% were non-Hispanic White, and the median (IQR) age of patients was 63 (54–71) years.

The financial problems experienced by the participants were evaluated through the COST-FACIT (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) and other domains of the problems (objects, attitudes, and behaviors) through the National Health Interview Survey (NHIS) questionnaire. ); Electronic medical records from each site provided age, sex, type of insurance, and disease data, and demographics were collected through an educational survey. The Health Insurance Literacy Measure (HILM) assessed consumers’ “ability to choose and use health insurance,” and 5 questions from the National Financial Capability Study assessed financial literacy.

Overall, 38% of study participants had private insurance and 72% had solid tumors, 42% had metastatic disease.

Almost half (49%; 95% CI, 44%-53%) of respondents reported financial problems, and this figure jumped by almost 20 percentage points, to 68% (95% CI, 63-72%), when they found out. from the NHIS questionnaire showed that the students had a problem of 1. This was observed even though 66% (95% CI, 60%-69%) also self-identified as having a high financial education.

The overall health insurance rate (SD) for health insurance through HILM was 64.9 (13.3), and according to the researchers, each increase of 10 corresponds to an 18% decrease in financial difficulties (the number of problems [OR], 0.82; 95% CI, 0.68–0.99; P = .04). However, this result was negated when financial education was considered. A HILM score below 60 indicated low health insurance coverage and was associated with financial problems, as well as physical and behavioral problems.

Fifteen percent of respondents reported a lack of health insurance knowledge and financial literacy; 50%, the sum of both; 14%, higher education in finance and less education in insurance; and 21%, higher education in health insurance and lower education in finance.

“Financial problems reported by patients are a growing problem in the provision of cancer care,” the study authors emphasized. “The study of health insurance and its association with financial problems in cancer patients, especially after controlling for financial skills, has not been well tested.”

With a low COST-FACIT score indicating severe financial distress, 49% of the study group had a median score of 27β€”an indication of any financial distress. In addition, physical, emotional, and behavioral problems were reported by 28%, 64%, and 13%, respectively.

Regarding financial knowledge, the median (IQR) was 5 (4-6) points, and 66% of respondents gave correct answers to at least 4 financial questions, which the authors of the study say shows that they had high financial skills. Fewer financial difficulties related to being a UMMC patient (OR, 3.04; 95% CI, 1.67-5.55), having a monthly household income under $5000 (OR, 2.00; 95% CI, 1.17-3.44), and being classified as “other or race” (OR, 2.10; 95% CI, 1.13-3.90), and having less than a college degree (OR, 3.44; 95% CI, 2.03-5.91). Furthermore, there was a 26-percentage point difference in the incidence of decreased financial education among those who did and did not report financial problems: 49% vs 23%.

“Financial loss due to treatment is a major problem for cancer patients that is associated with poor treatment outcomes and a high risk of bankruptcy,” the authors wrote. “Efforts by health plans, hospitals, and the federal government to improve the efficiency of health insurance can ensure that patients make better financial choices among different insurance companies based on their financial situation and medical needs, use their benefits more effectively, and continue to pay more than they can afford. cancer care.”

An editor accompanying this study agreed with the researchers’ findings, saying that improving the financial skills of patients through education-based programs can help empower patients and that financial managers can help “reduce patient and health care costs because managers connect patients to services and services designed to help find good..”


Khera N, Zhang N, Hilal T, et al. Association of Health Insurance Literacy and financial problems for cancer patients. JAMA Netw Open. Published online July 25, 2022. doi:10.1001/jamanetworkopen.2022.23141