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Risk of Bankruptcy Rises After Cancer Diagnosis

Washington State study shows young have highest risk

June 27, 2013

Written By Robin Warshaw
Reviewed By Joanna L. Fawzy Morales, Esq

People diagnosed with cancer are more than two-and-a-half times more likely to file for bankruptcy than those without cancer, according to a new study conducted in Washington state. Young people had the highest bankruptcy rates.

The study was published in Health Affairs.

Background and Reason for the Study

Medical and nonmedical expenses related to a cancer diagnosis can be sizable, even for those with health insurance. Out-of-pocket costs for copayments, deductibles and noncovered but needed services add up quickly.

Young women diagnosed with breast cancer may have no, or inadequate, health insurance. If employed, it maybe necessary for women to stop working while in treatment, causing a decrease in or loss of income and, possibly, loss of health insurance.

Filing for bankruptcy can be a last resort after pursuing all other options: financial assistance, payment plans with providers, and lump-sum payments to clear debts. Medical expenses can contribute to debt, yet there has been little study of how a cancer diagnosis relates to bankruptcy.

The researchers were interested in finding out how often and when bankruptcy occurs in those diagnosed with cancer.

Study Structure

Using a population-based cancer registry for western Washington state, the study included 197,840 women and men (evenly split) who had been diagnosed with various cancers from 1995 - 2009.

Each woman or man with cancer was matched with someone, called a control, from a larger database who did not have cancer but was of the same age, sex and zip code. Race was not included in the large database, so could not be used for matching.

Bankruptcy records of women and men from both the diagnosed and control groups were compared to determine incidence of bankruptcy, how long after diagnosis the filing was made, and other variables. Bankruptcy risk was not evaluated by financial situation at diagnosis, treatment type (finances could influence choice), or health insurance status.

Findings

Breast cancer was among nine cancers found to have the highest incidence of bankruptcy. Women diagnosed with breast cancer were:

  • 17 percent of the study population (34,195 of 197,840)
  • 23 percent of the total bankruptcies (1,017 of 4,408)
  • At greatest bankruptcy risk in age groups 20 - 34 and 35 - 49

Of all people diagnosed with cancer:

  • Most lived in urban areas—88 percent Caucasian,12 percent non-Caucasian
  • 2.2 percent filed for bankruptcy after diagnosis compared with 1.1 percent of controls
  • Bankruptcy filers were more likely to be young, female and non-Caucasian than others with cancer who did not file
    • Young people had two to five times higher bankruptcy rates than those 65 and older
    • Unmarried people were more likely than married people to file for bankruptcy

Study Limitations

Those included in the study lived in Washington state, which ranks 22nd out of 50 states in bankruptcy filings. Bankruptcy rates may be higher or lower in other states.

What This Means for You

You may be concerned about the financial impact of breast cancer treatment, especially if you are young. If you have health insurance, talk with the insurer about your coverage. Ask whether you need referrals or pre-approvals for care and which providers are in your network to reduce your out-of-pocket costs.

If you don’t have insurance, your doctor’s office, hospital social worker or the LBBC Guide to Understanding Financial Concerns may be able to direct you to state or federal agencies that can help. To learn more about finding affordable health insurance, go to HealthCare.gov.

At work, check with your employee benefits representative or supervisor about paid and unpaid time off, what happens to insurance coverage (if anything) if you take time off, and related issues.

Bankruptcy is not meant to be an easy solution, and it can have a long-lasting impact on you. Get legal and financial advice before considering filing for bankruptcy. This online resource from the Federal Trade Commission explains ways to find debt relief safely.

The LBBC Guide to Understanding Financial Concerns has advice on medical costs; federal and state programs for the uninsured; how to navigate insurance or apply for disability; tips if you’re having trouble paying your bills; and financial support resources. You might also want to call our toll-free  Breast Cancer Helpline at (888) 753-LBBC (5222).

Ramsey, S, Blough, D,Kirchhoff, A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis.HealthAffairs. 2013; doi:10.1377/hlthaff.2012.1263

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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