OBJECTIVES : Increasing evidence shows that patients may be under treated due to financial access barriers to appropriate care. It is ambiguous, however, whether the induced reduction of care varies across services among cancer survivors. This study aimed to evaluate the impact of financial access on use of primary care and inpatient/emergency department (ED) services among cancer survivors.

METHODS : A retrospective, pooled cross-sectional study was conducted using data from the National Health Interview Survey (NHIS), 2010- 2017. Financial access was measured as a “yes" response to any of the following NHIS survey prompts: “couldn't afford medical care”, “couldn't afford dental care”, “couldn't afford eyeglasses”, “couldn't afford mental health care”, “couldn't afford follow-up care”, or “couldn't afford specialists”. Multivariable logistic regressions were used to assess the impact of a self-reported financial access barrier on primary care (home health care visits, office visits) and inpatient care or emergency department visits in past 12 months, controlling for demographics, income, health status and insurance related information.

RESULTS : A total of 22,691 cancer survivors were identified out of 717,513 respondents during 2010-2017. Cancer survivors who responded “yes” to the survey prompt, indicating some degree of financial access barrier, had a 20% decrease in home health care visits (OR=0.80, 95% CI: 0.70 - 0.93, P=0.003), and 17% decrease in physician office visits (OR=0.83, 95% CI: 0.70 - 0.98, P=0.029). However, the same patients increased emergency department visits by 44% (OR=1.44, 95% CI: 1.32 - 1.57, P = 0.000), and hospitalizations by 2% (OR=1.02, 95% CI: 0.93 - 1.13, P = 0.640).

CONCLUSIONS : Financial access barriers may induce cancer survivors to reduce use of primary care services such as home care visits or physician office visits to save money. Unintended consequences of this response may be poorer health outcomes, and increased use of more costly services such as emergency department visits.