Health insurance knowledge and financial literacy do not prevent financial hardship in cancer patients

Cancer patients’ financial hardship has been shown to be an ongoing problem, even when they demonstrate high levels of health insurance knowledge and financial literacy, reports Open JAMA Network.

These cross-sectional study results were studied in 404 patients enrolled at Mayo Clinic in Phoenix, Arizona (n=299), from December 2019 through February 2020 and August through October 2020, and at the University of Mississippi Medical Center (UMMC) in Jackson (n=299). = 105) from September 2020 to February 2021. Fifty-four percent were female, 75% were non-Hispanic white, and the median age (IQR) of patients was 63 (54-71) years.

Participants’ financial difficulties were assessed via COST-FACIT (Comprehensive Score for Financial Toxicity – Functional Assessment of Chronic Illness Therapy) and specific domains of these difficulties (material, psychological and behavioral) via the National Health Interview Survey (NHIS) questions. ); electronic health records at each site provided data on age, gender, type of insurance, and disease, and sociodemographic data was collected through study surveys. The Health Insurance Literacy Measure (HILM) measured “a consumer’s ability to select and use health insurance,” and 5 questions from the National Financial Capability Study assessed financial literacy .

Overall, 38% of participants in their study had private insurance and 72% had solid tumors, with 42% having metastatic disease.

Almost half (49%; 95% CI, 44% to 53%) of the study population reported financial hardship, and this result jumped nearly 20 percentage points, to 68% (95% CI , 63-72%), when results from the NHIS questions revealed that participants had at least 1 area of ​​difficulty. This was observed even though 66% (95% CI, 60% to 69%) also reported having a high level of financial literacy.

The mean (SD) score for overall health insurance literacy through HILM was 64.9 (13.3), and according to the study investigators, every 10-point increase equated to an 18-point risk of financial hardship. Lower % (odds ratio [OR], 0.82; 95% CI, 0.68-0.99; P = 0.04). However, this result was negated when financial literacy was taken into account. A HILM score below 60 indicated low knowledge of health insurance and was associated with overall financial difficulties, as well as material and behavioral difficulties.

Fifteen percent of all respondents reported low levels of health insurance and financial literacy; 50%, high levels of both; 14% high financial literacy and low insurance literacy; and 21%, high health insurance knowledge and low financial literacy.

“Patient-reported financial hardship is a growing challenge in the delivery of cancer care,” the study authors noted. “Health insurance literacy and its association with financial hardship in cancer patients, particularly after controlling for financial literacy, has not been well examined.”

With a lower COST-FACIT score indicating greater financial hardship, 49% of the study cohort had a median score of 27, the indicator of any financial hardship. In addition, material, psychological and behavioral difficulties were reported by 28%, 64% and 13%, respectively.

Regarding financial knowledge, the median score (IQR) was 5 (4-6) points, and 66% of respondents provided correct answers to at least 4 questions on financial literacy, which, according to the authors of the study, indicates that they had high financial literacy. A lower likelihood of financial literacy is correlated with being a UMMC patient (OR, 3.04; 95% CI, 1.67-5.55), having a monthly household income below 5,000 $ (OR, 2.00; 95% CI, 1.17-3.44), classifying as “other race or ethnicity” (OR, 2.10; 95% CI, 1.13-3.90 ) and with less than a university degree (OR, 3.44; 95% CI, 2.03-5.91).In addition, there was a difference of 26 percentage points in the incidence of low financial literacy reported between those who reported and those who did not report financial hardship: 49% vs. 23%.

“Treatment-related financial hardship is a huge problem for cancer patients that has been associated with treatment nonadherence and higher risk of bankruptcy,” the authors wrote. “Efforts by health plans, hospitals, and the federal government to improve health insurance literacy can ensure that patients make financially wise choices among different insurance products based on their financial situation and their medical needs, use their benefits optimally, and keep their coverage affordable for recommended cancer care.

An editorial accompanying the study echoed the researchers’ findings, noting that improving patients’ financial literacy through education-based interventions can help empower patients and that financial navigators can help “reduce costs to patients and the healthcare system because navigators connect patients to supports and services that are designed to improve access.


Khera N, Zhang N, Hilal T, et al. Association of knowledge of health insurance with financial hardship in cancer patients. JAMA Netw Open. Published online July 25, 2022. doi:10.1001/jamanetworkopen.2022.23141