Not understanding terms like deductible, copay, premium, coinsurance, and out-of-pocket maximum prevents many Americans from selecting a health insurance plan that meets their financial needs. Fewer than 40% of patients enrolled in high-deductible healthcare plans engage in effective financial behaviors, such as comparing prices or discussing costs with clinicians. High costs are a barrier for many patients and survivors to access high-quality cancer and survivorship care.

In an article in the August 2022 issue of the Clinical Journal of Oncology Nursing, Edward et al. reported their findings on the prevalence of low cost-related health literacy among colorectal cancer (CRC) survivors, discussed the implications for access to survivorship care, and offered nursing strategies to address cost-related health literacy as a social determinant of health.

Cost-Related Health Literacy Among Cancer Survivors

Edward et al. defined health insurance literacy as “an individual’s knowledge, ability, and confidence to find health insurance plans; evaluate plans to select the best one that meets their financial and health needs; and use the plan to access timely and appropriate healthcare services.” Adequate health insurance literacy also requires numeracy, which Edward et al. defined as a person’s “ability to understand and use numbers in everyday life, which influences their ability to calculate out-of-pocket costs and make appropriate decisions on selecting insurance plans that meet their financial needs.”

The researchers surveyed a sample of 104 CRC survivors in the Kentucky Cancer Registry and measured their general health and health insurance literacy and numeracy using standardized assessment tools. Overall, most survivors (76%) had adequate general health literacy but less than half (45%) had high cancer health literacy.

On the financial measures, only:

  • 16% had high numeracy
  • 17% had high health insurance literacy confidence
  • 29% had high health insurance literacy behaviors
  • 46% had high health insurance literacy knowledge

Implications for Cancer Survivors

Edward et al. said that their study’s findings reflect the general American population as well as other cancer survivor subgroups. They explained that the specialized, intense testing and treatment that patients with chronic illnesses navigate only adds to their challenge of finding adequate health insurance coverage for their increased out-of-pocket costs.

Gaps exist in both the understanding of and interventions for the effects of this social determinant of health on cancer care. Research on the relationships between health insurance literacy and cancer screening, treatment adherence, and health-related outcomes is limited, Edward et al. said, but they cited some evidence that associated low health insurance literacy with medical nonadherence and delays or avoidance in accessing care. The authors added that practitioners have very few intervention options to promote cost-related health literacy among their patients, particularly cancer survivors.

Implications for Oncology Nurses

Nurses and other healthcare providers should assess patients for cost-related health literacy and initiate cost-of-care conversations as a regular part of patient education and management approaches, Edward et al. said. “Assessing for cost-related health literacy could be as simple as asking if the patient has ever had difficulties understanding their health insurance or medical bills.” Refer all high-risk patients to financial navigation resources and services.

All nurses should understand health insurance plans, cancer treatment costs, financial assistance programs, and financial navigators or resources. Equipped with that information, nurses can support cancer survivors’ treatment-related decision-making by ensuring they understand their costs of care and health insurance coverage options. Using standard assessment tools and initiating cost-of-care conversations about health insurance coverage, medical bills, debt, job, and income loss can also help nurses evaluate survivors’ needs and connect them with resources, Edward et al. added.

For more information about cost-related health literacy and financial toxicity, refer to the full article by Edward et al. or the resources listed in the sidebar.