Prevalence of financial and health insurance literacy and their association with financial hardship in cancer patients.

Abstract

70 Background: The prevalence of health insurance literacy (HIL) and financial literacy (FL) in cancer patients is not well described. Further, a better understanding of the association between these constructs and the domains of financial hardship (FH) can guide potential interventions. Methods: We examined the prevalence of HIL and FL and FH in cancer patients on active treatment at our institution. HIL and FL were assessed using Health Insurance Literacy Measure (HILM) and 5 questions from the National Financial Capability Study respectively. COST FACIT and National Health Interview Survey (NHIS) questions were used to examine overall FH and its 3 domains (material, behavioral and psychological hardship). Pearson correlation coefficient was used to describe the relation between the COST score and FH domains assessed by NHIS questions. Logistic regression analysis was performed to determine the associations of overall FH (measured by COST FACIT) with FL and HIL. Results: Among 256 patients approached, 202 completed questionnaires. Median age was 67 (range 22 to 91) years. 51% were male, 93% Whites and 5% were Hispanic. 69% had a solid tumor with 37% stage IV. Median number of lines of treatment was 4 (range 1 to 18). 21% were currently employed, 59% had ≥college degree, 41% had private insurance and 42% had monthly income≥$7000. 50% participants answered at least 4/5 FL questions correctly, indicating high FL. Being male, White, having insurance, higher education and income ≥$7000 were associated with higher FL. 72% of participants had high HIL, and they were more likely to be Non-Hispanic, married and have received more lines of treatment. FL significantly correlated with HIL (r = 0.29, p < .001). 65% patients endorsed FH based on NHIS questions (10% behavioral, 20% material, and 62% psychological hardship). 48% patients had FH based on a COST score < 28 (Median score), which correlated with material (r = -0.59, p < .001), psychological (r = -0.55, p < .001) and behavioral FH (r = -0.42, p < .001). The association between FH and HIL was not significant (OR 0.78; p = 0.08), though higher FL was associated with lower FH (OR 0.69; p = 0.02). Conclusions: Despite high FL and HIL (as compared to national standards), the prevalence of FH in our relatively affluent patient cohort was high, driven mainly by psychological hardship. We did not find strong association between the HIL and FH unlike in the reported literature. Our findings behoove us to develop tailored interventions to address unique domains of the FH in a diverse population.