Deductibles, copays, coinsurance, and other cost-sharing mechanisms are designed to discourage people from seeking unnecessary medical care, thereby slowing down the rising healthcare costs. However, according to a new study by The Commonwealth Fund, as out-of-pocket costs increase and family incomes decline, these measures are instead causing people to postpone or deny themselves care that they actually need.
As part of the ongoing Health Care Affordability Tracking Survey, this study focuses on how much adults with private insurance are spending on deductibles and copays, and how those expenses are affecting decisions concerning their health.
Of those surveyed, 13% had deductibles equal to 5% or more of their incomes. Of this group, 40% said they hadn’t seen a doctor when they were sick, declined a preventive care test, missed a recommended follow-up test, or didn’t get necessary care from a specialist. The 23% of respondents with deductibles that were less than 5% of their income had similar results. 43% of those who took the survey agreed it was either somewhat or very difficult or impossible to afford their deductible, with that number rising to 58% for those earning less than 100% of the federal poverty level, and 64% among those earning between 100% and 199%.
While not as much of a burden as deductibles, copays and coinsurance can still affect healthcare decisions. The survey found that almost 25% of respondents said it was very or somewhat difficult or impossible to afford copays for medical treatment and prescriptions. That proportion reached 40% for those with incomes that were below the federal poverty level.
Because of copayments, lower-income adults delayed or avoided care twice as often as adults with higher incomes. 46% of insured adults with incomes under 200% of poverty stated that because of copayments or coinsurance, they hadn’t filled a prescription, not gone to the doctor, skipped a medical test or follow-up, or not seen a specialist when they or their physician thought it was necessary.
Patients who choose to postpone or deny themselves care due to financial concerns may eventually develop more serious and costly conditions. The healthcare industry needs to find new ways to discourage unnecessary care, while ensuring their patients are well taken care of.
Author: Lauren Daniels