Exploring Hidden Costs and Experienced Financial Protection Among Insured Cancer Patients: A Cross-Sectional Study in Indonesia

Abstract

Health economics and healthcare financing increasingly emphasize financial protection as a core goal of equitable health systems. In cancer care, national health insurance can reduce direct medical payments, yet patients may still face hidden costs, including transport, accommodation, income loss, caregiver-related expenses, and uncertainty about uncovered services. However, little is known about how insured cancer patients experience these hidden costs during treatment. This study examines how hidden costs create a gap between formal insurance coverage and actual financial protection, leaving patients financially vulnerable despite insurance enrolment.. Using an interpretative phenomenological approach combined with patient-centered hidden cost mapping, this study explored the lived experiences of cancer patients enrolled in national health insurance. The analysis identified five central themes: formal coverage without full financial reassurance, hidden nonmedical costs as an everyday burden, loss of income and disrupted household stability, family-based coping as both support and moral pressure, and treatment decisions shaped by hope, affordability, and uncertainty. These findings indicate that financial toxicity is not only an economic burden, but also a relational, temporal, and emotional experience that shapes how patients understand treatment continuity and family dependence. The study advances health financing scholarship by reframing financial protection as a lived sense of security, not merely as insurance status, and suggests that future research should examine how hidden costs evolve across illness trajectories and healthcare systems.