PatientEngagementHIT

High Patient Financial Responsibility Reduces Positive Outcomes

Patient financial responsibility is growing, which 30 percent of patients reporting more costly health insurance. This may be impeding positive outcomes for patients.

One in four patients who skimp on healthcare due to high financial responsibility see their conditions decline in the long-run, shows a recent survey conducted by Morning Consult and the American College of Emergency Physicians (ACEP).

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According to the survey of 2,016 registered voters, patient financial responsibility is getting in the way of access to emergency healthcare, which could make conditions worse in the long-run.

"As a physician, it greatly concerns me that people are waiting until their medical conditions deteriorate to seek emergency care, which can have lifelong consequences," said ACEP President Jay Kaplan, MD.

Thirty percent of patients report that their healthcare coverage has gotten worse of the past year, while only 15 percent said their coverage has gotten better. Fifty-five percent of respondents say they are paying more for their healthcare coverage than they did last year, and 20 percent say they pay “much more” for coverage.

As a result, 30 percent of patients reported avoiding emergency treatment out of fear of high costs. Nineteen percent are trying to access other seemingly less costly services such as urgent care centers or doctor’s offices and being sent directly to emergency care because of critical conditions.

"This is a scary environment for patients," said Rebecca Parker, MD, FACEP, president-elect of ACEP.

"Patients can't choose where and when they will need emergency care and should not be punished financially for having emergencies. No insurance policy is affordable if it abandons you in an emergency."

According to Kaplan, this situation is dangerous because it could prompt patients to begin self-diagnosing. Patients may think their chest pains are indigestion when they are in fact something far worse. By prolonging their treatment, patients may leave themselves and the industry liable to higher healthcare costs.

Worsening health insurance coverage is also placing a burden on providers, Kaplan said.

“Now insurance companies are exploiting a federal law, [Emergency Medical Treatment and Labor Act], which guarantees that no one will be turned away from an emergency department, in order to reduce payments for emergency care,” Kaplan explained. “They are shifting costs onto patients and medical providers."

Increased government regulation and policymaking may help improve health insurance offerings and patient healthcare access, Parker said.

“State and federal policymakers need to ensure that health insurance plans provide adequate rosters of physicians, affordable deductibles and co-pays and fair payment for emergency services,” Parker asserted.

“We encourage all patients to investigate what their health insurance policy covers and demand fair and reasonable coverage for emergency care."

Patient financial responsibility challenges persist despite high patient satisfaction, shows a separate survey from The Physicians Foundation. While over 90 percent of patients are satisfied with their primary care providers, one in four patients are going without treatment due to high costs.

Eighteen percent of patients have skipped doses of medication due to high costs, while 27 percent have avoided filling the prescription altogether.

Additionally, two-thirds of patients are concerned with paying off their medical bills and 40 percent have medical debt.

The survey also indicated patient difficulties with health insurance affordability. One in five patients think their primary care copay is unaffordable and 57 percent say their specialist copayment is unaffordable. Thirty-nine percent of patients say their deductible is too high and 34 percent say their premium is too expensive.

According to Physicians Foundation President Walker Ray, MD, policymakers are not the only ones responsible for mitigating this problem.

“Affordability of care has unquestionable impact on access,” Ray explained. “It is incumbent upon the entire healthcare community to ensure patients have access to quality healthcare services that they feel they can actually afford. Otherwise outcomes suffer.”

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