Patient Responsibility News

High Out-of-Pocket Costs Hamper Care Access for 30% of Patients

High out-of-pocket costs are impacting patient access to care for patients from various socioeconomic strata, the poll showed.

out-of-pocket costs

Source: Thinkstock

By Sara Heath

- Patients are still delaying treatment as a means to manage high out-of-pocket costs, marking a decade-long trend in the medical industry, showed a recent Gallup poll.

Twenty-nine percent of US patients delayed healthcare in 2018 because of high patient financial responsibility, revealed Gallup’s annual Health and Healthcare poll.

Those findings are consistent with results from Gallup’s poll since 2005. Before then, only about 20 percent of patients delayed care because of high costs.

These findings may suggest a tapering off of increasing healthcare costs, the survey authors suggested. After all, the biggest spike in patients delaying treatment due to cost is over ten years in the past.

“Despite ever-increasing healthcare costs in the US, the rates of Americans' putting off care in general, as well as for serious conditions in particular, have been fairly flat over the past 13 years, after rising in the mid-2000s,” Gallup authors wrote. “That may be good news in the face of ever-increasing US healthcare costs and a surge in high-deductible plans.”

READ MORE: Insured Patients See High Premiums, Out-of-Pocket Healthcare Costs

However, these findings may also be indicative of a healthcare system riddled with cost issues that impact patients even as the proportion of individuals covered by insurance increases.

“But, this also means that the reduced percentage of uninsured Americans since passage of the Affordable Care Act, as well as provisions in the ACA law meant to contain costs, have not been enough to drive down the overall rate of unmet care,” the authors added.

What’s more, patients are putting off care for symptoms that reportedly deserve medical attention, the poll showed. Over half of those who reported delaying care (19 percent of patients, total) said they delayed treatment for serious or somewhat serious symptoms.

Again, this is consistent with the poll’s findings over the past decade, Gallup said.

The poll also found consistency in who was delaying treatment. Unsurprisingly, patients without payer coverage were most likely to delay treatment due to high costs (54 percent). Those with private insurance were the second most likely to delay treatment because of costs (30 percent), followed by patients with government Medicare or Medicaid coverage (22 percent).

READ MORE: Price Transparency Essential to Lower Out-of-Pocket Patient Costs

Those with private insurance saw the biggest spike in the number of patients delaying care because of cost. The number of patients delaying care rose from 21 percent in 2005 to about 30 percent each year since then.

Conversely, those covered by Medicare or Medicaid saw a more modest increase in the number of patients delaying care due to cost. Before 2005, 18 percent of publicly-insured individuals delayed care; after that, the proportion of those delaying care rose to 22 percent.

This trend likely emerges because of the nature of each populations’ plans. While most patients are facing nearly untenable costs for their insurance coverage, patients with commercial or employer-sponsored healthcare have seen spikes in financial responsibility.

Because more patients are enrolling in high-deductible health plans, they owe more money before their insurance kicks in. This could discourage patients from seeking healthcare, the survey authors explained.

“After paying steep health insurance premiums, or in some cases funding their own medical spending accounts, Americans with health insurance are often still responsible for large deductibles and co-pays that inhibit them from visiting a doctor for every medical symptom,” the authors wrote.

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

“That may be an appropriate check on public demand for healthcare services, helping keep US costs down, but it also prevents some Americans from seeking treatment for more serious medical conditions,” they continued.

The rise in healthcare costs are impacting patients from all economic groups, the survey authors said.

Although patients from the lowest socioeconomic group are significantly more likely to delay care due to cost than those from the highest group, the increase in the number of patients doing so since 2005 is similar between economic strata.

For example, 7 percent more low-income patients delayed care after 2005 than did before 2005. Similarly, 7 percent more high-income patients delayed care after 2005 than did before 2005. Eleven percent more middle-income earners delayed care after 2005 than they did before, the survey showed.

Other experts have suggested high healthcare costs is one of the biggest obstacles to patient care access. As such, healthcare professionals have called on policy reforms that would make it easier for patients to manage those costs and still access healthcare.

For example, policymakers have proposed mandates for better price transparency and measures to protect patients from surprise medical bills. Although these proposals would not lower the actual cost of care, they could help patient manage their personal finances for healthcare and empower patients with knowledge to make healthcare decisions.


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