Although the Affordable Care Act (ACA) reduced the uninsured rate, patients continue to report pressing financial strain caused by unpaid medical bills (copays, out-of-pocket drug costs, high deductibles) and medical travel costs, according to a letter published in JAMA Internal Medicine.

Researchers characterized the use of crowdsourcing to fund oncology care needs by identifying the top 20 most prevalent cancers in the United States using data from the National Cancer Institute. Each cancer by US state was queried on for 1000 individual searches (50 states multiplied by the 20 most prevalent cancers), which identified 37,344 cancer support campaigns on October 7, 2018. Researchers used a randomizer to select 1035 campaigns to be studied in detail. Insurance status of the campaign author was determined by their own self-reporting on whether they were underinsured or uninsured.

The median fundraising goal was $10,000 (interquartile range [IQR], $5000-$20,000), and the median donation amount obtained was $2125 (IQR, $860-$5475). The most common campaign purposes were paying medical bills (41%), medical travel (25.3%), and nonmedical bills (23.2%). Patients who were underinsured made up 26.2% of the population and requested $10,000 more on average in their campaigns compared with those who did not mention insurance (n=178 [65.7%] vs n=245 [32.1%]; P <.01)., Patients who were underinsured were also more likely to reported unstable employment and prior surgical treatment compared to those who were not.

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This study is limited by the lack of generalizability to other patients, the difficulty in determining the veracity of online claims, and that insurance status was self-reported.

In this study, researchers found that the underinsured seek but do not receive higher donation amounts. Although the ACA has reduced the insurance rate, not all patients have been subject to the cost containment measures provided by the statute. Researchers also speculated that regionalization of oncologic care may improve treatment outcomes but increase the financial burden on patients by increasing medical travel costs. Overall, the results suggest that the growing financial burden of health care will require greater attention and advocacy.


Cohen AJ, Brody H, Patino G, et al. Use of an online crowdfunding platform for unmet financial obligations in cancer care [letter; published online September 9, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.333