by Kim Krisberg
In the United States, getting better often comes with an unfortunate and devastating side effect: financial bankruptcy. In fact, a 2009 study in five states found that between 2001 and 2007, medical-related bankruptcies rose by nearly 50 percent. And for those diagnosed with cancer, the risk is even worse.
As if a cancer diagnosis wasn’t scary enough, a group of researchers recently calculated that cancer patients are more than two-and-a-half times more likely to go bankrupt than people without cancer. And younger cancer patients faced bankruptcy rates of two to five times higher than cancer patients ages 65 and older. This illustrates the great benefit of universal systems and social supports such as Medicare and Social Security, explain the authors of a recently published Health Affairs study.
In examining and linking patient data with records from the U.S. Bankruptcy Court for the Western District of Washington, study researchers discovered that between 1995 and 2009, of the more than 197,800 people diagnosed with cancer, more than 4,400 filed for bankruptcy after being diagnosed with the disease. In a comparison group of more than 197,800 people without cancer, only about 2,290 filed for bankruptcy.
“This is the strongest evidence we have between a disease and risk for severe financial distress,” study co-author Scott Ramsey, an internist and health economist at Fred Hutchinson Cancer Research Center in Seattle, said in a news release. “I’ve not seen other studies that linked databases of this quality.”
The study noted that the costs of treating cancer — including co-payments, deductibles, child care, lost income and support services — can be financially overwhelming even for those patients with health insurance. For example, between 40 percent and 85 percent of cancer patients have to stop working during their initial treatments, and many will face barriers to working long after treatment ends. The authors noted that while definitive links between serious illness and bankruptcy can be “controversial” due to self-reporting, incomplete data and varying definitions of medical bankruptcy, this study went to great lengths to uncover reliable incidence and time course data links between bankruptcy filings and new cancer diagnoses.
Researchers found that cancer patients who filed for bankruptcy tended to be young, female, nonwhite, and had localized or regional-stage disease versus distance-stage cancer (“localized” means the cancer is confined to the organ of origin; “regional” means the cancer has spread beyond the organ of origin; and “distance” means the cancer has spread far from the primary tumor). Bankruptcy rates varied by cancer, with thyroid and lung cancers having the highest correlation. Younger people had higher bankruptcy rates across all cancer types when compared to those ages 65 and older — in fact, the youngest age groups studied (the study was confined to those 21 years old and older) had up to 10 times the bankruptcy rate as their older counterparts. Study authors Ramsey, David Blough, Anne Kirchhoff, Karma Kreizenbeck, Catherine Fedorenko, Kyle Snell, Polly Newcomb, William Hollingsworth and Karen Overstreet wrote:
The youngest cohorts in our study were diagnosed at an age when debt-to-income ratios are typically highest — often unavoidably, because people are paying off student loans, purchasing a home, or starting a business. All working-age people who develop cancer face loss of income and, in many cases, loss of employer-sponsored insurance, both of which can be devastating for households in which the patient is the primary wage earner.
In contrast, the authors noted that for Medicare beneficiaries, “having stable insurance (specifically coverage not tied to employment) plays a major role in mitigating the risk of bankruptcy for those over age sixty-five.”
The study concluded that employers and lawmakers could play important roles in reducing the risk of medical bankruptcy, such as offering tax incentives for employers to provide supplemental insurance that covers household and out-of-pocket costs in the year following a cancer diagnosis. In addition, they called on cancer care providers to measure a patient’s financial health “as a matter of course.”
To read the full study, visit Health Affairs.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.