Financial Assistance Pays for some health care for those over age 65 or with disabilities who have made social security payments Pays for some health care for certain categories of persons with low income Approximately 85% of Americans have some health insurance to help pay certain acute health care costs; far fewer have short- and long-term disability insurance

cost sharing for outpatient mental health care (50 percent)12 compared with general medical visits (20 percent).

This situation has substantial implications for the receipt of psychosocial services. When people without insurance need treatment for cancer, they must begin a search to locate health care providers in their community who will treat them at no or reduced cost, are willing to work out a payment plan, or some combination of these.13 Once they are successful in locating such a provider, they may be unlikely to have the energy, time, or other resources to repeat the search to locate another provider who will provide mental health services on a similar basis—services they may not even anticipate needing at the outset of their illness. Grateful to the provider of their biomedical treatment, they may be unwilling to ask the facilitator of those services to subsidize as well the cost of any mental health services. Heavy out-of-pocket costs for the biomedical treatment of their cancer may also make them less willing to seek out mental health services, which they may view as of lower priority than the treatment of their life-threatening cancer. As a consequence, they are at risk of foregoing those services. Members of the American Psychosocial Oncology Society (APOS) report the frequent failure of patients with cancer to pursue or continue mental health care because of limited insurance coverage (APOS, 2007).

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12However, visits for medication management require only a 20 percent copayment.

13See, for example, http://www.natlbcc.org/nbccf/access/affordable.html or http://www.breastcancer.org/faq_insurance.html.



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