This is what rationing health care looks like in America: one in two people in families dealing with a chronic health condition have difficulty affording paying medical bills before meeting a deductible, unexpected medical bills, co-payments for prescription drugs, co-payments for physician visits, and/or their monthly health insurance premium.
That financial toxicity is felt among people who were insured through the workplace in late 2018, based on the Kaiser Family Foundation (KFF)/LA Times Survey of Adults With Employer-Sponsored Insurance, published last week.
Some 51% of people told KFF that they or a family member had skipped or postponed getting health care or a prescription in the past twelve months due to cost. Six in ten people with a higher deductible self-rationed care; 45% of those with a lower deductible self-rationed care, and 40% of those with no deductible skipped care. So while having a deductible does increase the risk of self-rationing care due to cost, nearly half of people without a deductible do so, too.
People with lower household incomes are at greater risk of self-rationing, up to $75,000. But 47% of families earning $75K and over indeed skip care, as well.
Being sick worsens one’s risks of self-rationing.
People with chronic conditions also tend to skip care more than people without chronic issues — but again, 40% of people without chronic conditions skip or postpone health care due to cost.
A key factor underpinning this self-rationing health care behavior is peoples’ lack of savings.
Two in three U.S. workers with insurance with higher deductibles could not pay a bill equal to that deductible without going into debt, the second chart shows. One-third pay in full at the time of the service, and 27% pays on a credit card paying off over time. 16% won’t pay the bill at all.
Again, these people who need to borrow or go into debt to pay their medical bills are health-insured through their job.
For this study, KFF/LA Times surveyed 1,407 U.S. adults between 18-64 (working age) between September and October 2018.
Health Populi’s Hot Points: In my book, HealthConsuming: From Health Consumer to Health Citizen, I devote the first two chapters to the state of Americans’ financial health: in the first, We Are All Health Consumers Now, I track the growth of high-deductible health plans coupled with the rising risk-shift of medical spending to patients — financially nudged toward the persona of health care consumer.
In Chapter 2, I assert that The Patient is the Payor, facing first-dollar payment for health care up to the deductible — essentially self-insured until that point. Historically, since the advent of employer-sponsored health care during World War II, the payor was the employer, the union, a government agency, another plan sponsor. With growing deductibles, copayments and coinsurance, the patient emerges as the payor, and one that the KFF study tells us can’t cover costs through savings.
More than 1 in 5 working Americans aren’t saving anything at all, Bankrate found in early 2019. About one-half of working people are saving something, but no more than 10% of their incomes.
HealthConsuming points out that Americans aren’t good savers compared with peers living in other countries — including those that levy much higher taxes.
In those countries, national spending on social care tends to be greater as a proportion of GDP than health care spending, I point out in Chapter 7 on ZIP Codes, Genetic Codes, Food and Health. Spending on education, clean and safe environments, public transportation systems, and financial and job security bolsters overall wellness — stemming downstream medical care costs. And health citizens in these countries don’t know the concept of financial toxicity that has become a mainstream side effect in U.S. healthcare.
137 million U.S. adults experienced medical financial hardship between 2015 and 2017. The last vertical bar chart comes from the study by the American Cancer Society finding that over half of people had problems with affordability, stress, or delaying health care due to cost.
This study, published in the peer-reviewed Journal of General Internal Medicine, looked beyond the financial toxicity caused by a cancer diagnosis, exploring the prevalence of medico-financial hardship across medical conditions beyond oncology.
The study analyzed data from the 2015-2017 National Health Interview Survey conducted by the CDC. In conclusion, the researchers warned that, with trends toward greater patient cost-sharing and increasing health care costs, the risks of financial medical hardship could increase in the future.