Cancer patients shouldn’t be responsible for out-of-pocket costs

“In 2023, just under 2 million Americans will be diagnosed with cancer. Many will endure multiple CT and MRI studies and intensive medical care, including surgery, radiation, chemotherapy, or immunotherapy. Fortunately, advances in treatment and novel therapies have steadily improved survival following a cancer diagnosis. Cancer death rates have declined by 27% over the past 20 years.

Unfortunately, many American cancer patients also face an unexpected adverse effect: financial toxicity. The costs of cancer are literally killing patients. But there is a clear solution. Patients diagnosed with cancer should not be responsible for any deductibles, copays, or other cost-sharing. [..]

Deductibles, copayments, and coinsurance are meant to ensure patients have “skin in the game.” These costs are intended to discourage what is called “moral hazard” — by raising costs, out-of-pocket payments are meant to disincentivize the use of unnecessary, inefficient, or discretionary medical services. The aim is to make a healthy person think twice before requesting a costly MRI for lower back pain that is not medically indicated or opting for the more expensive of two equally effective drugs. But such insurance plan structures are illogical and wrong for a person diagnosed with cancer for whom an unexpected, high volume of expensive medical services is necessary for survival. [..]

Financial toxicity is uniquely American. Cancer patients in other countries do not experience this side effect. [..]

There must be safeguards to prevent abuse. Patients should receive only evidence-based treatment, and doctors should choose the most cost-effective treatment option. [..] But this cost accountability should rest with the cancer doctors who make the testing and treatment recommendations, rather than the patient. [..]

This policy would not be cost-prohibitive. It is calculated that all American cancer patients, including survivors long after they received their cancer treatments, pay about $16 billion in out-of-pocket costs for their cancer care, or about 8% of all costs for cancer care. A policy of no deductibles, copays, or coinsurance for cancer — especially if focused on the year after initial diagnosis, which is when patients’ costs are highest — should run considerably less, about $2,500 per person or $5 billion annually, roughly 2.5% of total cancer spending. [..] And if physicians are paid for adopting the lowest cost, most effective treatments, this is likely to induce a concomitant behavior change in the tests and treatments they order, leading to some savings for payers, too.

Why single out cancer over other conditions? While eliminating cost sharing for all chronic illnesses that require expensive treatments over extended periods would be the best policy, this is unlikely to happen, given the U.S. political climate. Disease-by-disease changes to policy are not optimal and I have argued against them. Nevertheless, historically this is the American way — witness $35 insulin for diabetes. Hence, cancer is a good place to start because many more cancer patients face financial toxicities and bankruptcies than patients with other conditions.”

Full article, EJ Emanuel, STAT News, 2023.5.23