Both low- and high-income women who are switched to high-deductible health plans (HDHPs) experience delays in breast cancer diagnosis and treatment, according to a study published in the March issue of Health Affairs.

J. Frank Wharam, M.B., B.Ch., M.P.H., from Harvard Medical School in Boston, and colleagues examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among women whose employers switched their insurance coverage from health plans with low to high deductibles between 2004 and 2014. Data were included for 54,403 low-income women and 76,776 high-income women continuously enrolled in low-deductible plans for one year and in HDHPs for up to four years. These women were compared to matched controls who remained in low-deductible health plans.

The researchers found that low-income women in HDHPs experienced relative delays of 1.6, 2.7, 6.6, and 8.7 months to first breast imaging, first biopsy, incident early-stage breast cancer diagnosis, and first chemotherapy, respectively. Shorter delays were seen for high-income HDHP members, but these delays did not differ significantly from those of low-income counterparts. Delayed breast cancer care was also experienced by HDHP members living in metropolitan, nonmetropolitan, predominantly white, and predominantly nonwhite areas.

"Such delays could lead to adverse long-term breast cancer outcomes affecting a substantial proportion of commercially insured women who develop breast cancer," the authors write.

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