Health Information Management

Higher out-of-pocket costs may make patients less likely to seek care

Case Management Insider, December 23, 2014

Case managers may want to keep new and troublesome trend on their radar. A recent Commonwealth Fund survey shows that Americans are increasingly paying more out of pocket for their healthcare—and it may make them more hesitant to see the doctor.

The Commonwealth Fund, a New York City-based private foundation that aims to promote health system improvements found that more than one out of every five Americans ages 19–64 spent 5% or more of their yearly income on healthcare costs outside of premiums. More than 10% of the 2,592 people surveyed in this age group spent 10% or more, according to the survey. Researchers found this increase across the board whether an individual purchased insurance through their employer or on their own.
“Adults with low incomes had the highest rates of steep out-of-pocket costs,” reported the Commonwealth Fund. “About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.”
It’s something case managers should watch, says June Stark, RN, BSN, Med, director of care coordination, St. Elizabeth’s Medical Center in Boston. “We are still in the beginning of healthcare reform, so as case managers like everyone, we are learning as we go,” she says. “One of the emerging results that is appearing undesirable is that the increasing insurance premiums and co-pays are starting to keep some patient populations away from seeking timely care.”
The hope is that the trend won’t affect patient care, says Stark. Patients who delay treatment often wind up being sicker when they do come in. “The risk is that we will be creating a population of sicker patient, which is anti-intuitive to the purpose of healthcare reform,” she says.
The trend could also have implications after discharge. If a patient doesn’t get needed follow-up care, he or she could wind up back in the hospital as a readmission—something hospitals are looking to prevent. With this in mind, case managers may want to consider ensuring that conversations with the patient not only focus on follow-up care but whether the patient can actually afford those recommended treatments after discharge.


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