Cancer: Finding New Approaches to an Epidemic
Jun 1, 2012
Cancer is raging out of control. Every conversation that touches this subject seems to elicit a response about a brother, sister, parent or close friend who has been touched by this epidemic. The rates of diagnoses have been steadily on the rise and most tragically the demographic hardest hit, have been children. Treatment has also changed as death rates have slowly fallen as new and more elaborate treatments have emerged. This has also resulted in a huge upswing in out-patient treatments, as the shift away from lengthy hospital stays continues.
Lung cancer remains our most deadly variety, killing more people than any other form of cancer. Breast cancer is the No. 2 killer for women and prostate cancer is No. 2 for men. Lung cancer has now become the leading cause of death in China as poor air quality and heavy smoking has contributed to a nearly five-fold increase since the 1970s.
Research has tackled the treatment of cancer, providing the response to keep this epidemic from overwhelming our health system. But along with these medical treatment advances has come rapidly rising costs. One example is in cancer drug costs, currently predicted to rise as much as 15% a year through 2013. In the United States, the overall cost of cancer treatment had already topped $124 billion in 2010. Medical treatment advances have moved the standard intravenous method to oral drugs that now account for 25% of the total drugs administered. However, the downside is that the pills are more expensive, have higher co-pays and are reimbursed by health plans at a lower rate than IV drugs. This pattern is being repeated in other treatments that are growing in costs.
What is surprising is how this trend is impacting those with excellent health insurance coverage. Many find that health insurance covers the biggest cost of cancer treatment but the out-of-pocket portion remains an ongoing struggle. Couple that with the rise in other unexpected costs like lost work, travel to appointments and out-of- pocket costs that average $712 per month for co-payments for doctor visits and prescription drugs, and the recipe for financial disaster looms large. Rates of medical debt are growing among those with health insurance. According to the American Cancer Society (ACS), 1 in 5 privately insured Americans with chronic conditions have problems paying their medical bills. When out-of-pocket medical care exceeds 2.5% of income, financial burdens become substantial. Another study in Washington state compared cancer registries to bankruptcy records and found that with lung cancer the possible bankruptcy was 8% versus 0.3% in the general population.
What can be done to address the issues? First, employers have a big stake in keeping employees healthy. That means educating them that most preventive coverage on the health insurance would include a cancer screening benefit. Make certain that employees are well-informed about their own health, since early prevention is the “best medicine” for fighting cancer. The Centers for Disease Control have set goals for cancer wellness screening. These goals, as reported in 2010 are still lagging with breast cancer screening rates at 72.4%, below the target of 81%; cervical cancer screening was at 83%, below the target of 93% and colorectal cancer screening was at 58.6%, below the target of 70.5%. This simply requires employees taking their own health care into account and using the tools provided by their employer-sponsored health insurance plans.
Second, employers can help address the financial impact by offering voluntary cancer or dread disease policies to supplement their health insurance. These plans will fill in the gaps left by the health insurance and assist in making certain that the financial impact of cancer is minimized. The second most expensive condition that is covered under employer-sponsored health plans is cancer. A recent report from Delta Air Lines’ health insurance plan indicated that 25% of the high-cost claimants’ expenses and 16% of the overall plan’s costs came from cancer. This being a snapshot of one employer indicates how much employees with health insurance are affected by cancer treatment costs. The key is to select a supplemental plan that addresses the new reality of cancer treatment and prevention through wellness exams. A supplemental cancer plan should include a wellness benefit that supports the cost of annual cancer screening. Some of the older plans stressed prolonged hospital stays during cancer treatment, which is actually a rarity today. Some of the important benefits that should be included are:
- Chemo and radiation treatment
- Drugs and medicine
- Transportation and lodging benefit
- Experimental treatment benefit
- Bone marrow/stem cell treatment with a donor benefit
These can certainly be supplemented by additional benefits such as second and third opinions, coverage for skin cancer, prosthesis, and cancer maintenance therapy.
Employees are grappling with the high cost of health care and the costly epidemic of cancer is creating new setbacks in that effort. These plans, with their pre-tax advantages, can go a long way to close that gap at no cost to the employer.
Steven L. Beumer
National Benefit Service Center