With American families contributing a growing proportion of their personal income to health care, researchers find patients are consequently experiencing a range of social, medical, financial and sometimes legal disruptions resulting from high out-of-pocket expenses.
In interviews with 33 insured patients seeking philanthropic financial assistance, all of whom faced major chronic illnesses and most of whom were covered by Medicare, researchers found patients experienced considerable anxiety and major debt problems, as well as disruptions of medical care because of high levels of cost sharing.
Participants described various borrowing strategies (e.g., credit cards), legal problems (e.g., debt collections), and threats to their nonmedical household budgets (e.g., food, housing). Although participants understood their health benefits with exceptional detail, they described considerable anxiety about changes to those benefits that could easily disrupt carefully managed household budgets.
Specifically, benefit designs that resulted in large variation in financial liability from month to month (e.g., large deductibles or coverage gaps) imposed considerable financial challenges. As health care cost sharing grows, the researchers urge policy makers to consider the consequences of high cost sharing for families facing strained household budgets.
Continuity of benefits and month-to-month stability of financial liability are important considerations that may be undervalued in policy discussions.
Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures, By David Grande, MD, MPA, et al, University of Pennsylvania, Philadelphia