Citizens self-rationing care due to cost
Americans skipped recommended medical tests and procedures, cut pills, and skipped dental care due to cost in the past year.
Welcome to the world of rationing, borne not from a government program, but of private sector market forces.
With all due respect to Adam Smith, market forces don't always work in the best interests of public health.
The latest iteration of Kaiser Family Foundation's Health Tracking Poll published February 25, 2009, found that 53% of Americans did at least one self-rationing health behavior because of cost in the past year (roughly February 2008 to February 2009).
The most common health behavior driven by cost concerns is using home remedies and over-the-counter drugs as a substitute for going to the doctor, reported by 1 in 3 people. 1 in 3 also skip dental care or checkups.
1 in 4 Americans put off needed visits to postpone necessary care, as well as skip prescribed tests or procedures.
1 in 5 Americans don't fill prescription drugs that doctors recommend, and 15% of Americans split pills to conserve the meds for future use. Finally, mental health gets short-shrift when it comes to cost, as 7% of Americans
Health Populi's Hot Points: Most Americans are worried about health care costs; 45% told KFF they are "very" worried to pay more for care and insurance -- the highest percentage Kaiser has found since 2006.
Most Americans well-understand that health insurance coverage is tied to employment: 56% are very worried about affording health care they need when they believe someone in their household will lose a job this year.
And the covered worker is also worried: 34% of people with health insurance are worried they will lose coverage.
Last night, President Obama kicked off his first speech to Congress with the words,
"I know that for many Americans watching right now, the state of our economy is a concern that rises above all others....You don’t need to hear another list of statistics to know that our economy is in crisis, because you live it every day. It’s the worry you wake up with and the source of sleepless nights....The impact of this recession is real, and it is everywhere."
The recession is driving health rationing among Americans. The personal short-term fiscal choices like pill-splitting and foregoing preventive tests due to copays and coinsurance will inevitably lead to longer-term physical consequences.
posted by Jane Sarasohn-Kahn at
6:37 AM
3 Comments:
One caution: It is generally accepted that a significant number of doctor visits and prescriptions that patients think are "needed' are, in fact, wasted care. This includes a large number of doctor visits and antibiotics for routine viral infections.
Heck, the routine annual physical is often an expensive waste for otherwise healthy adults. I cannot count how much money I spent over the years doing followup visits to my old doctor to "go over lab results." This was simply a way to bill twice for what was actually one episode of care, as the lab work could have been done before the physical and covered at the same visit. If I was paying the entire bill out of my pocket, I frankly wouldn't have tolerated it. But, with insurance and a small copayment, I went along.
Even though I have great insurance, I am the one prompting my doctors for generic drugs and resisting their attempts to switch me from cheap generics over to expensive brand names. Why do I need to take a brand-name prescription for fish oil ($35 copyment!) when I can buy it cheaper over the counter? Why should I stop taking cheap generic Simvastatin and over-the-counter Niacin to go to a BRAND-NAME prescription version that combines the same exact two items together -- but costs a whole lot more!
I agree that truly needed care can be skipped, but some folks may be deciding that taking junior to the doctor for each sniffle and demanding antibiotics is not something they are willing to do if they pay the full costs involved.
If patients start looking at the bills and wasteful practices, some of them may be stopped. One lady 57patient in Texas raised Holy Hell over a hospital charging her $147 dollars for a pregnancy test prior to some surgery. It turns out they do it for all female patients. Do pregnancy tests cost $147 dollars when consumers buy them over-the-counter? Do you know many 57 year olds that get pregnant?
The trick is going to be separating out the care that is appropriate from that which was actually unneeded.
The upside is that maybe some of the messaging on the value of "cheap prevention" may finally be heeded. Proper diet, exercise, and healthy lifestyles cost less than doctors and pills -- and are more effective in preventing chronic diseases.
By
Anonymous, At
February 25, 2009 11:31 AM
Hi, Anonymous, thanks for your comment. Agreed that oftentimes, more health care is not better. More "health" is. I highly recommend Shannon Brownlee's "Overtreated" book on this topic.
Under the details of KFF's data, it's very clear that at lower household incomes, these trends are strong. Having said that, even people at higher income levels are rationing.
What will bolster sound decision making among health citizens will be to arm them with empowering, current and personally relevant information that will enhance these health decisions. Thanks for your comment!
By
Jane Sarasohn-Kahn, At
February 25, 2009 11:48 AM
Jane:
I read Overtreated and enjoyed it a lot. It may only scratch the surface of the wasted care.
By
Anonymous, At
February 25, 2009 8:38 PM
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