High-Deductible Health Plans and Mortality Among Cancer Survivors.

Abstract

Patients with cancer have high utilization of health care services, and many have high financial burdens from care. High-deductible health plans (HDHPs), which offer lower premiums at the expense of higher deductibles and possibly higher out-of-pocket costs, are associated with decreased care utilization among survivors of cancer. However, it is unclear whether HDHPs are associated with cancer outcomes. To determine whether HDHP status is associated with survival among cancer survivors and individuals without history of cancer and whether financial barriers to care mediate associations between HDHP status and survival. This cross-sectional study included US adults ages 18 to 84 years who participated in the National Health Interview Survey from 2011 to 2018. Data were analyzed from December 14, 2023, to December 1, 2025. HDHP status. Outcomes of interest were overall survival (OS) and cancer-specific survival (CSS). Analyses were adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, and cancer site and time since cancer diagnosis (if applicable). A total of 147 254 respondents (mean [SD] age, 45.7 [16.4] years; 79 261 [50.9%] female) were identified, including 9799 (5.9%) with history of cancer. A total of 2331 cancer survivors (25.6%) and 37 473 individuals without history of cancer (28.5%) reported an HDHP at the time of NHIS participation. HDHP status was associated with worse OS (hazard ratio [HR], 1.46; 95% CI, 1.19-1.79) and CSS (HR, 1.34; 95% CI, 1.01-1.77) among cancer survivors. In contrast, among adults without history of cancer, HDHP status was not significantly associated with OS (HR, 1.08; 95% CI, 0.96-1.21; P for interaction = .001). In mediation analyses, HDHP status among cancer survivors was associated with increased financial barriers to care, which mediated approximately 30% to 70% of the total association of HDHP with survival. In this cross-sectional study of nationwide population-based data, HDHPs were associated with worse OS and CSS among cancer survivors. However, HDHPs were not associated with mortality in adults without history of cancer. These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.