Cancer is Very Expensive
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work, Emeritus
SEPTEMBER 26, 2018
Coping with the High Cost of Cancer Care
The cost of cancer is often now referred to as financial toxicity and is included in the list of other major dangers faced by cancer patients. Did you know that medical bills are the major cause of bankruptcy in the US? Even if we step away from politics and any conversation about the Affordable Care Act or Obamacare, we can all agree that our medical expenses are increasing. Every year, when insurance plans are updated, it seems that our co-pays and deductibles go up. Have you ever gone to the pharmacy to fill a new prescription and been shocked by the requested co-pay? Certainly you have opened medical bills that describe a less than robust payment by your insurance company, leaving a bigger balance for you to cover.
Here are some unhappy facts about cancer and money: earnings drop 40% within two years of diagnosis and remain low although overall family finances generally recover; and the increased financial burden is the single largest predictor of poor quality of life and psychological health among cancer survivors.
As you think about it, it is easy to understand the many factors that contribute to these worries. Even people with steady jobs and good benefits often have a smaller income stream during treatment and recovery; sick pay or disability may be less than regular income, especially if normally there are supplements from overtime or other bonuses. Some people have jobs that don’t pay at all if they don’t show up for work; this too often becomes a reason for missed appointments and treatments. The combination of less income and increased costs too often make trouble. The extra bills are directly related to medical expenses as well as more generally to life: transportation and parking at hospitals, more childcare or other hired household help, more purchased meals, the cost of any complementary (CAM) therapies such as acupuncture or massage that are rarely reimbursed by insurance.
Triage Cancer is an excellent organization that offers a number of useful resources for cancer patients. They have just developed a simple and practical information sheet that breaks this all down into insurance coverages both in and out of network, practical expenses, personal expenses, and information about employment and disability insurance. Take a look at this checklist; it can help you organize your expenses, budget and thoughts. Note, too, that their website has information about other financial resources.
If your treatment center is like the Cancer Center at Beth Israel Deaconess Medical Center, financial counselors may be available to help you understand and address your situation.
Recently there has been a lot of discussion about the responsibility of oncologists to discuss the costs of particular treatments with their patients. In reality, this does not happen very often. The reasons are many: it is an awkward conversation, time is limited, every insurance policy is different and most doctors don’t know the cost of drugs they are suggesting. (A good question: should they know?)
What can you, the patient, do to preserve your financial health? If you are talking with your doctor about a new treatment, you can certainly ask what she knows about the cost and whether your insurance will cover it. You do not want to find yourself at the pharmacy to learn, as have some people whom I have know, that there is a $5000 co-pay for a month’s worth of pills. If your doctor does not know about the likely expense, ask how long the drug has been around. Generally speaking, it is the new drugs that are the most expensive—often by a lot. The next important question is whether the proposed new drug is actually more effective than an older version? Sometimes the tried and true older medication is almost as good or even just as good.
There is no single or easy answer to any of this. It is really important, however, that value is part of all of our decisions, and it is right that these choices be made in a thoughtful and responsible conversation with our doctors. They need to be prepared for these discussions, and we need to ask to have them.
Share your experiences and thoughts with the BIDMC Cancer Community at cancercommunity.bidmc.org.