Affordability and access to care
Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.Dr. Martin Luther King, Jr. , Civil rights leader
Affordability and access to care at a glance
The cost of medical care can be a barrier to receiving effective treatment. Beyond direct medical costs, cancer treatment can have many indirect costs for people: transportation, lost wages, extra child care or elder care, counseling, support for daily household tasks, and help with your basic care at home.
Further barriers to effective medical care may be part of the neighborhood and social environment that you live in. The lack of medical professionals and services in your community can interfere with your ability to get prompt and effective treatment. Other barriers may include these:
- Unsafe housing, transportation, and neighborhoods
- Racism, discrimination, and violence
- Limited education, job opportunities, and income
- Lack of access to nutritious foods and opportunities for physical activity
- Polluted air and water
- Language and literacy barriers
Resources are available to help you overcome both financial and other barriers to care.
On this page
Costs of cancer care
Treating cancer is expensive. The national cost of cancer treatment in the US in 2020 was $158 billion and is projected to be $246 billion by 2030.1Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiology, Biomarkers & Prevention. 2020 Jul;29(7):1304-1312. Financial burdens, also called financial toxicity, can be substantial for people with cancer.2Zhu Z, Xing W, Zhang X, Hu Y, So WKW. Cancer survivors’ experiences with financial toxicity: a systematic review and meta-synthesis of qualitative studies. Psycho-Oncology. 2020 Jun;29(6):945-959. Annual treatment for breast cancer in the US can cost between $20,000 and $100,000,3Exley R. This woman paid over $225,000 to beat breast cancer. Health insurance didn’t cover her bill. CNBC. October 22, 2020. Viewed January 29, 2022. with total costs more than $200,000.4The Costs of Breast Cancer. Web MD Cancer Center. 2021. Viewed March 25, 2022; Trogdon JG, Baggett CD et al. Medical costs associated with metastatic breast cancer in younger, midlife, and older women. Breast Cancer Research and Treatment. 2020 Jun;181(3):653-665.
More than 40% of patients deplete their life savings (an average of $92,000) within 2 years of diagnosis.5Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. American Journal of Medicine. 2018 Oct;131(10):1187-1199.e5. Expense is a huge consideration and even a barrier for many patients.
Most people diagnosed with cancer have anxiety about finances. A third of people with cancer said insurance issues—such as deductibles and copays, pre-authorization requirements, or lack of prescription coverage—make receiving the best care difficult. To reduce the cost of cancer care, those living with cancer, families members, and caregivers report taking steps that may negatively affect treatment outcomes, such as delaying or failing to fill prescriptions. Most caregivers have made personal financial sacrifices such as dipping into savings or delaying retirement to help pay for cancer treatment.6ASCO 2020 National Cancer Opinions Survey. American Society of Clinical Oncology. October 2020. Viewed January 18, 2022.
Understanding your finances and how to minimize your financial burden can ease stress and improve your quality of life.
What influences the cost of cancer treatment?
Factors affecting the cost of your medical care
- Your type of cancer
- Your treatment plan
- Treatment location
- Your health insurance coverage
- Transportation: gasoline, tolls, parking, public transit, or air fare
- Child care
- Elder care
- Support for daily tasks such as house cleaning, cooking, laundry, or pet care
- Care assistance at home
Further adding to financial burdens, people with cancer may be unable to work, and career advancement can be interrupted.7Rajagopal L, Liamputtong P, McBride KA. The lived experience of Australian women living with breast cancer: a meta-synthesis. Asian Pacific Journal of Cancer Prevention. 2019 Nov 1;20(11):3233-3249. Caregivers for spouses with cancer are also impacted, with higher risk of financial instability compared to other health conditions.8Bassett M. Caring for spouse with cancer linked to ongoing financial instability. MedPage Today. April 13, 2023. Viewed April 16, 2023.
Questions for your oncology team
Discuss with your treatment team how your cancer diagnosis may impact your financial situation. Some examples of questions that may be helpful are listed here.9Questions to Ask about Cost. Cancer.Net. March 2018. Viewed January 18, 2022.
Treatment plan costs and options
- Who can help me estimate the total cost of the recommended treatment plan?
- Do you have any financial conflicts of interest in proposing this treatment plan for me?
- Does my health insurance company need to approve any part or all of the treatment plan before I begin treatment?
- Is the treatment center that you are recommending in my insurance plan’s network?
- Is this medication on my health insurance plan’s preferred drug list?
- Can I switch to a less expensive brand-name or generic drug within the same drug class?
- If I cannot afford this treatment plan, can we consider other treatment options that do not cost as much?
- Do any programs help cover the costs of my drug(s) for cancer treatment or side effects?
- Should I plan financially for long-term medical care, such as a nursing home, or for hospice care?
Understanding bills and insurance
- When is payment due?
- Do I have a co-pay for my visits?
- Who can help me understand my bills?
- Who handles concerns and questions about health insurance in this office or medical center?
- Will this person help me figure out my medical bills and the codes on the bills to make sure they are correct?
- If an insurance claim is denied, who can help me file an appeal?
Support for non-medical expenses
- Can someone help me organize my expenses, keep track of incoming bills, and plan my budget?
- Is free or low-cost transportation available at the medical center where I will have treatment?
- Are reduced parking rates available for patients at the medical center or doctor’s office?
- Do any organizations help patients pay for transportation to and from treatments and medical appointments?
- If I am traveling a long distance, are any free or reduced-cost hotels or lodging near the treatment facility?
- Do you offer payment plans?
- If I need multiple visits to a doctor’s office, do you have a policy allowing me to pay the co-pay only once or not at all (a waiver)?
Questions for your insurance company
- Does my insurance cover other doctor visits, such as for a second opinion?
- What expenses does my health insurance cover if I need to be admitted to the hospital?
- What expenses does my health insurance cover if I receive treatment as an outpatient?
- What is my prescription co-pay for my medication?
If you need assistance with either medical or nonmedical expenses, ask if your treatment team has a social worker or can refer you to programs to help you address your needs.
Consumer Financial Protection Bureau
The Consumer Financial Protection Bureau warns against using costly medical credit cards and loans that are being pushed on patients. “These medical credit cards and installment loans have largely replaced the low- or no-cost informal payment plans offered to patients directly by their medical providers. Instead, the medical financial products are generally more expensive than other forms of credit. Patients who use them may find themselves facing fees, interest charges, and adverse financial outcomes they didn’t anticipate.”10Henderson J. New report warns of medical credit cards, loans pushed on patients. MedPage Today. May 5, 2023. Viewed May 18, 2023.
CancerChoices Senior Clinical Consultant Laura Pole, RN, MSN, OCNS: Think twice before using your credit card to pay your medical bills, especially if you won’t have the money to pay off the credit card when it comes due the next month. Hospitals and medical offices often offer payment plans with much more reasonable terms and interest rates. Once you charge the bill to the credit card, you no longer have the ability to negotiate your bill with the facility or doctor who provided your medical care.
My brother, for example, had a medical emergency that landed him first in the emergency department, then in the intensive care unit (ICU). At discharge, he felt pressured by the hospital to pay the out-of-pocket costs with his credit card. He was still weak and vulnerable and felt as though he had to give them an answer right then, without consulting a family member or an advocate. So he handed them the credit card. A better decision would have been not to agree to pay by credit card and ask to have someone from the business office call him about making payment arrangements. That decision to pay the large bill with a credit card saddled him in credit card debt that took years to pay off.
Helpful links for financial assistance
Can complementary or self care reduce costs of cancer care?
Self-carein cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture approaches have low costs and may even save you money. We provide links to many free or low-cost resources to help you eat well, move more, sleep well, manage stress, share love and support, eliminate tobacco use, reduce alcohol, and bring your body to a better weight—all of which are directly linked to better outcomes and reduced risk of recurrence.
Complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture cancer care includes a wide range of therapies and costs, from low-cost supplements or over-the-counter drugs to very expensive treatments that may also involve travel. We report and rate the general level of expense for each of the complementary therapies we review.
Most complementary therapies support your wellness and healing, but few have shown substantial ability to treat cancer. In our view, complementary therapies cannot replace curative conventional treatments, but many may reduce the unpleasant side effects and perhaps enhance the effectiveness of conventional therapies. You’ll need to consider the costs of complementary care in the context of all your cancer care costs:
- Direct costs and benefits: Complementary therapies may not be covered by insurance, and measuring direct impacts on your health and wellness is difficult. Some evidence has found a higher risk of financial catastropheout-of-pocket cancer-related costs 30% or more of annual household income and medical impoverishmentreduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs among people with cancer using complementary therapies in upper-middle-income countries in southeast Asia. Risks were higher for economically disadvantaged households.11Kong YC, Kimman M et al; ACTION Study Group. Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study. Lancet Global Health. 2022 Mar;10(3):e416-e428. We encourage you to carefully consider the strength of evidence, plus the costs, of any therapy you are considering. Our reviews of therapies summarize and rate both the evidence and the relative costs.
- Indirect costs and benefits: If complementary therapies may help you remain well enough to keep working during or after treatment, the cost could be more than offset by your earnings. Similarly, if you would need to hire help to care for your family or yourself, and use of some complementary therapies could keep you well enough to reduce these costs, then these therapies may be cost-effective.
- Insurance coverage: Some insurance plans cover some complementary therapies, such as acupuncture or massage. Check your insurance regarding coverage.
Once you know your likely costs of complementary therapies, we encourage you to ask your doctor, integrative medicine team, and insurance provider about low-cost or no-cost options that may be available for complementary therapies.
Other barriers to care
Non-medical factors and cancer outcomes
Inequalities in economic, educational, health care, and other environments can contribute to poor health. These inequalities can interfere with your ability to access and pay for health care. The lack of medical professionals and services in your community—even if cost is not a barrier—can impact your ability to get prompt and effective treatment.
Inequalities can also contribute to other health conditions that may reduce an individual’s or a whole community’s wellness and resilience. These inequalities can affect your health, your ability to access care, your ability to pay for health care, and your quality of life. They may also impact your cancer treatment outcomes.
The lack of transportation to medical services can impact access to care and outcomes.
- Higher emergency department use and all-cause mortality among adults with a cancer history with transportation barriers compared to those without transportation barriers in a very large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study12Jiang C, Yabroff KR et al. Transportation barriers, emergency room use, and mortality risk among US adults by cancer history. JNCI: Journal of the National Cancer Institute. 2023;djad050.
Addressing barriers to care
If you feel that you have one or more barriers to your medical care, ask your oncology team or hospital if a social worker or patient navigator is available to help you.
“A cancer patient navigator is an individual trained to help identify and resolve real and perceived barriers to care, enabling patients to adhere to care recommendations and thus improve their cancer outcomes.”13Braun KL, Kagawa-Singer M et al. Cancer patient navigator tasks across the cancer care continuum. Journal of Health Care for the Poor and Underserved. 2012 Feb;23(1):398-413.
Research studies have found that navigators can reduce inequities in care.
- “For patients of color, with low income, and with housing insecurity, having a patient navigator basically eliminated the disparities in cancer care. Those patients no longer had the delays in treatment. Their time to treatment and completion of treatment looked the same as any other patient.”14Patient navigators can help when life disrupts cancer care. American Cancer Society. April 19, 2021. Viewed January 20, 2022; Rodday AM, Parsons SK et al. The impact of patient navigation in eliminating economic disparities in cancer care. Cancer. 2015 Nov 15;121(22):4025-34.
- A dedicated nurse navigation program aided in producing similar patterns of care and outcomes comparing minority patients and white patients with aggressive large B-cell lymphoma.15Nze C, Flowers CR. Potential impact of nurse navigation program in achieving equitable care and outcomes in patients with aggressive large B-cell lymphoma. ASCO Post. December 10, 2021. Viewed January 20, 2022; Hu B, Boselli D et al. Equal access to care and nurse navigation leads to equitable outcomes for minorities with aggressive large B-cell lymphoma. Cancer. 2021 Nov 1;127(21):3991-3997.
If you do not understand your care, you have the right to ask for clarification. If you are experiencing a language barrier, ask for an interpreter. By doing so, you may be helping future patients as well as yourself.
If you are unsure about the treatment plan you are given, you have the right to seek a second (or third) opinion from another physician or health facility.
Everyone deserves to be treated with respect. If you feel you are experiencing racist or discriminatory actions, speak up. You have several options for “speaking up.”
If you feel that you are being unfairly treated by your health care team because of your race, ethnicity, income, or housing status, or if you do not understand your care, we encourage you to bring this up with your team. If you are not comfortable talking with your team or if you are not getting the help you need, The Joint Commission has the following recommendations:16Speak Up™ Against Discrimination. The Joint Commission. May 2021. Viewed January 29, 2022.
- Find out about the policy at the hospital or health care organization for reporting complaints. If possible, try to work with the organization.
- Talk to the organization’s patient advocacy department (sometimes also called the patient liaison office or the patient advocacy team).
If you’re not satisfied with the response or outcomes from the hospital or institution, these options are available.
Your city, county, or state may have an office within the health department that deals with health care quality. You can contact this office with complaints, and you may get a quicker response time than from a federal government agency.
Helpful links on barriers to care
Helpful links for legal issues
Are you a health professional?
Many people with cancer experience financial toxicity, and some have unmet needs even after adjustments.17Zhu Z, Xing W, Zhang X, Hu Y, So WKW. Cancer survivors’ experiences with financial toxicity: a systematic review and meta-synthesis of qualitative studies. Psycho-Oncology. 2020 Jun;29(6):945-959. Financial burdens can even cause some people to discontinue treatment.
Referring patients to social workers, patient navigators, or others who can help them navigate and manage financial issues is a core offering in many cancer centers and hospitals. If you don’t already access these resources for your patients, consider finding out what’s available in your area and adding information to your resources for patients.
Helpful links for professionals
Keep reading about how to integrate your choices