Cost-sharing may cause patients to forgo, delay care, doctors say

In a newly published paper, the American College of Physicians suggests methods to reduce the risk of people skipping care because they cannot afford it.

By Stephen Feller

PHILADELPHIA, July 13 (UPI) -- With increases in the cost of health insurance deductibles, and the increasing prevalence of cost-sharing for many healthcare services on insurance policies, many patients may delay or forgo care because they cannot afford it.

The American College of Physicians is concerned people still cannot afford access to high-value tests and procedures even since the implementation of the Affordable Care Act, suggesting methods by which people can gain greater access in a paper published on the organizations' website.


Even with the 2010 implementation of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, the doctors' organization says the prevalence of cost-sharing requirements in insurance policies increases the cost of care for people who cannot afford it.

"An alternative approach is needed to reduce spending through systemic reform of the health-care sector, protect low-income workers from overly burdensome out-of-pocket costs, enhance subsidies for marketplace Quality Health Programs, increase health care literacy, and direct shoppers to the right type of plan so that patients are shielded from financial ruin and insurance can function as intended," Dr. Nitin Damle, president of the ACP, said in a press release.


Chief among the group's five recommendations is to reduce overall healthcare spending in ways that don't just shift costs onto insured people who may not be able to afford them.

Encouraging the use of high-value healthcare -- reducing or eliminating additional consumer costs for tests and treatments known to provide the greatest health benefit -- may increase its use, based on research by groups without a financial interest in the outcome of the studies.

Pegging some of the out-of-pocket costs to individuals' income would also help to reduce the potential of patients forgoing care, the doctors group writes in the paper.

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Additionally, they recommend improving provisions under the PPACA to protect consumers from obscenely high cost-sharing schemes, working to help consumers better understand the insurance products they buy, and implementing tests to find the long- and short-term effects of cost-sharing.

With low-income consumers, as well as the very sick, most likely to have plans that include cost-sharing elements, the doctors say addressing the problem with effective healthcare in mind, rather than basing it simply on dollar value, could improve the system and help people.

"Underinsurance is emerging as a serious problem that may be more difficult to tackle than un-insurance," Damle said. "Evidence shows that when cost sharing is imposed, consumers may respond by reducing their use of both necessary and unnecessary care."


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