Patient Responsibility News

Healthcare Costs Limit Patient Access to Care for DoD Beneficiaries

Fifteen percent of TRICARE beneficaries said high healthcare costs limit patient access to care, reflecting a nationwide trend with high prices.

healthcare costs patient access to care

Source: Thinkstock

By Sara Heath

- Patients enrolled in the Department of Defense’s military health plan are facing high healthcare costs, hampering adequate patient access to care and patient satisfaction, according to a recent survey from the Military Officers Association of America (MOAA).

The survey of 8,500 beneficiaries of the military health plan, TRICARE, are unhappy with the plan’s current options. Compared to survey results from December 2017, fewer patients are content with their care options and the prices they pay to receive healthcare.

Far fewer patients report they are very satisfied with their medication costs, for example. Previous surveys found 42 percent of patients very satisfied with their out-of-pocket medication costs, a number that has decreased to 28 percent today. Twenty-two percent of respondents remain satisfied or somewhat satisfied with cost of medications.

Rising healthcare costs are also leading to patient concerns about healthcare affordability, the survey revealed. Over half of the most recent respondents said they are unsure of whether they can afford their medical care, a number unparalleled in previous plan satisfaction surveys, MOAA said.

In fact, healthcare cost concerns pose a substantial barrier to care as more TRICARE beneficiaries postpone their care because of cost concerns.

READ MORE: Patients Unprepared for Out-of-Pocket Costs for Long-Term Care

Ninety-four percent of patients said they had never delayed or canceled treatment because of high costs in December 2017. In this most recent survey, that number dropped to 85 percent of patients who said they had canceled or postponed care because of high costs.

Cost issues varied depending on enrollment status, the report added. Patients enrolled in TRICARE Prime or Select – TRICARE’s managed care organization and fee-for-service plans, respectively – were more likely to say they had delayed care due to cost compared to patients with TRICARE for Life, the plan’s Medicare add-on.

Of those patients who said they had delayed care due to cost, 10 percent said they had done it one or two times, 3 percent three or four times, and 2 percent five or more times.

Most patients skip out on specialty care appointments, which are notable for being higher-cost and more difficult to obtain than other types of treatment. Beneficiaries most frequently missed mental health and physical therapy appointments, the survey revealed.

Increases in copays serve as one of the foremost financial barriers to care, the report revealed. In an open response portion of the survey, patients reported significant spikes in their copays for specialty care.

READ MORE: Health Payers See High Patient Satisfaction Despite Cost Concerns

“Because the copays went from $12 to $30, it is hard for me to afford therapies for my 4-year-old son,” one respondent said. “He is supposed to receive speech therapy twice a week and occupational therapy once a week. Under the old way it, was $36 every week. Now I am paying $90 every week. We only do speech and occupational once a week because it has put a financial strain on us. It is hard to provide the adequate care for my son who has special needs that should be met.”

To add insult to injury, patients reported that these price increases did not come with quality improvements.

“You do not improve a service, medical or otherwise by charging a higher price,” another patient asserted. “Charging more and doubling the fees in [TRICARE]  Prime or TRICARE Select doesn't make the medical plan any better. It's like selling a $20,000 car for $30,000. It is the same car, not any better parts or options. Gave it a new name and charge more for it. This does not improve the service or the car just because you charge more for the service. Congress ups the copays for drugs, ups enrollment fees, doctor copays, but they don't seem to want to improve the product.”

These results follow changes made to TRICARE that affected patient access to care for plan year 2018. Most of these changes impacted family members of active duty service people, who do not receive their care in military treatment facilities.

Family members were automatically enrolled into TRICARE Prime, TRICARE’s managed care organization offering, unless family members opted for another plan.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

Patients enrolled in TRICARE Select, the fee-for-service plan option, will face enrollment fees between $150 and $300 starting in 2020. The Government Accountability Office (GAO) plans to monitor how these fees will improve healthcare quality, if at all.

TRICARE beneficiaries are not alone in managing financial barriers to care. Data from February 2018 showed that 64 percent of all patients avoid healthcare because of high costs. Sixty-one percent of patients said they have little to no medical savings set aside in case of a healthcare emergency.

As health plans continue to increase patient financial responsibility for care, patients will likely see persistent care barriers. It will be essential for healthcare stakeholders and policymakers to put a cap on these out-of-pocket patient costs that hinder both patient satisfaction and access to care.


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