ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2018
Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2021Pooled it
- Patient Out-of-Pocket Costs and Healthcare Utilization Related to Mastectomy vs Breast Conservation: A Claims-Based Study.Journal of surgical oncology · 2026Article
- What do health insurance deductibles do to health care spending growth?International journal of health economics and management · 2026Article
- Modeling the Arc of Financial Well-Being in Breast Reconstruction: A Mixed-Methods Study.Plastic and reconstructive surgery · 2026Article
- Examining the Efficacy of Coarsened Exact Matching as an Alternative to Propensity Score Matching.Statistics in medicine · 2026Article
- Longitudinal Associations Between Financial Toxicity and Health-Related Quality of Life for Patients With Cancer.JCO oncology practice · 2026Article
- High-Deductible Health Plans and Mortality Among Cancer Survivors.JAMA network open · 2026Article
- Cardiovascular disease and diagnosis of advanced prostate cancer.Cardio-oncology (London, England) · 2025Article
- Cardiovascular Disease and Breast Cancer Stage at Diagnosis.JAMA network open · 2025Article
- Redefining Cancer Screening Coverage-Screening to Diagnosis.JAMA health forum · 2024Article
- Trajectories and influencing factors of social anxiety in postoperative breast cancer patients.BMC psychiatry · 2024Article
- Decision for Carpal Tunnel Surgery: High-deductible Health Plans versus Traditional Health Plans.Plastic and reconstructive surgery. Global open · 2024Article
- Association of High-Deductible Health Plans and Time to Surgery for Breast and Colon Cancer.Journal of the American College of Surgeons · 2023Article
- Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States.JCO global oncology · 2023Article
- "It's just not easy to understand": A mixed methods study of health insurance literacy and insurance plan decision-making in cancer survivors.Cancer medicine · 2023Article
- Multidimensional financial hardship among uninsured and insured young adult patients with metastatic breast cancer.Cancer medicine · 2023Article
- Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?Medical care · 2023Article
- Cost-Related Access Barriers, Medical Debt, and Dissatisfaction with Care Among Privately Insured Americans.Journal of general internal medicine · 2023Article
- Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram.JAMA network open · 2023Article
- Impact of High-Deductible Health Plans on Breast Reconstruction: Considerations for Financial Toxicity.Plastic and reconstructive surgery · 2023Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Purpose High-deductible health plans (HDHPs) require substantial out-of-pocket spending and might delay crucial health services. Breast cancer treatment delays of as little as 2 months are associated with adverse outcomes. Methods We used a controlled prepost design with survival analysis to assess timing of breast cancer care events among 273,499 women age 25 to 64 years without evidence of breast cancer before inclusion. Women were included if continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a HDHP (at least $1,000 deductible) after an employer-mandated switch. Study inclusion was on a rolling basis, and members were followed between 2003 and 2012. The comparison group comprised 2.4 million contemporaneously matched women whose employers offered only low-deductible plans. Measures were times to first diagnostic breast imaging (diagnostic mammogram, breast ultrasound, or breast magnetic resonance imaging), breast biopsy, incident early-stage breast cancer diagnosis, and breast cancer chemotherapy. Outcomes were analyzed by using Cox models and adjusted for age-group, morbidity score, poverty level, US region, index date, and employer size. Results After the index date, HDHP members experienced delays in receipt of diagnostic imaging (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.94 to 0.96), biopsy (aHR, 0.92; 95% CI, 0.89 to 0.95), early-stage breast cancer diagnosis (aHR, 0.83; 0.78 to 0.90), and chemotherapy initiation (aHR, 0.79; 95% CI, 0.72 to 0.86) compared with the control group. Conclusion Women switched to HDHPs experienced delays in diagnostic breast imaging, breast biopsy, early-stage breast cancer diagnosis, and chemotherapy initiation. Additional research should determine whether such delays cause adverse health outcomes, and policymakers should consider selectively reducing out-of-pocket costs for key breast cancer services.
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