While at times successful, medical crowdfunding can amplify or create issues of patient privacy, medical validity, and social disparities. The practice itself is a reaction to rising healthcare costs that outsize people’s wallets. Even the insured are increasingly relying on medical crowdfunding to cover out-of-pocket (OOP) expenses. In response to people assuming exorbitant OOP costs that can lead to declaring bankruptcy, there’s been a question as to who should instead assume the financial burdens. One approach is to address ways to reduce financial toxicity.
Financial toxicity, according to Ezekiel J. Emanuel, MD, PhD, an oncologist and vice provost for global initiatives at University of Pennsylvania, refers to how the OOP cost of cancer treatment for those affected creates emotional anguish with potential to adversely impact aspects of people’s lives, from medication adherence to income loss. In the op-ed, Dr. Emanuel references data from many studies to explain “financial toxicity.” Cancer treatment can cost at least $42,000 for the first year of care. At least 40% of Americans deplete their savings to pay for the first 2 years of care; approximately 30% with cancer have trouble paying for long-term cancer-related costs; and the mortality risk for people with cancer who filed for bankruptcy was 80% greater compared to those that didn’t. Dr. Emanuel notes the majority of those experiencing financial toxicity have insurance, and he attributes the malady to OOP expenses from high-deductible health plans.
High-deductible health plans, according to a study in JAMA Oncology, are cost-sharing measures meant to lower people’s use of health care services. In a Knowledge at Wharton article, three faculty members explain how raising the deductible (hence, “high-deductible”) means the copay or coinsurance amount people pay also goes up before insurance kicks in. The analysis discusses that, for people not using health insurance regularly, high-deductible plans can be a solid choice. Compared with traditional plans, they have a lower monthly premium and might include a health savings account (HSA) or health reimbursement arrangement (HRA) that employers contribute to. But that aside, the intention of high-deductible plans was to reduce medical spending through dissuasion. In other words, if OOP expenses were high, then people wouldn’t want to use medical services in excess or would at least think twice before scheduling an appointment. What happened instead? OOP spending for high-deductible plans grew 67% within a decade.
Regarding cancer-related costs, the researchers explain how high-deductible plans create exorbitant OOP costs for patients and those price tags lead to financial toxicity. With that, the study also asserts that financial toxicity is the driving force behind medical crowdfunding, which, incidentally, rose 20% for cancer in 2023.
A KFF Health News article gives three suggestions to improve cost of care that apply to cancer-related financial toxicity: health insurers revisit high-deductible plans and question the value given that many patients on high-deductible plans can’t even afford treatments; health entities (eg, physician groups and hospital systems) vet bills for patients and reevaluate policies for collecting payments; and, physicians nationwide denounce the cost of care on behalf of patients. This final point happens to agree with an opinion from the American Medical Association Code of Medical Ethics, which stipulates physicians should advocate through political participation to remove financial barriers to patients. In Dr. Emanuel’s STAT News op-ed, he recommends eliminating cost-sharing but based on medical service, how routine it is, and whether it’s the most cost-effective option. He ultimately contends that physicians shoulder the burden. That, however, requires revisiting legal statutes.
According to the Knowledge at Wharton article, high-deductible health plans help the bottom line for companies. That’s a side effect, in addition to financial toxicity, of more than 70 million people on high-deductible plans assuming greater OOP responsibility. In that sense, for the sake of net income, companies are choosing to include a health plan option known to create financial toxicity for their employees that end up needing cancer treatment. If high-deductible plans are a financial boon for companies, then perhaps a solution is for companies to not only diversify health plan offerings, but also modify them to accommodate different salary brackets, or match the fullest amount the IRS allows them to contribute to qualifying tax-exempt HSA or HRA. Of further consideration, companies can also ensure their employees are better educated about the different plans. This could make for informed enrollment decisions with the potential to reduce any cost surprises at physicians’ offices.
Any of these viewpoints could be a step toward reducing financial toxicity and potentially decrease reliance on medical crowdfunding, which could help reduce the social and health issues it can perpetuate.