Avoiding appointments, treatments, and even the ER; the rising cost of healthcare services in the US is a leading contributor to our patients’ hesitancy to seek care. Despite access to a span of medical information and innovative technology, along with a relatively stable economy, the U.S. also has one of the highest costs of healthcare in the world.
While there is a myriad of contributors that have placed such an exorbitant price tag on medical care, many have emerged from the concept of cost-driven healthcare. This model’s effect on patients avoidance has led to a lower retention rate and, in many cases, greater vulnerability to illness.
This article will examine some of the factors that have led to these high prices and how unaffordable care has impacted patients and physicians.
The High Price of Healthcare
People in the United States spend an average of $10,000 every year on healthcare, more than any other country. As the price of healthcare increases faster than the economy can keep up with, so does inflation; currently higher than any other US industry.
These cyclically growing costs are perhaps the largest barrier to healthcare in the country. Many patients are no longer able to afford the healthcare services they need. According to a survey conducted by the ACEP, one out of every four individuals who are financially forced to reduce the amount of healthcare they receive see their medical conditions deteriorate. Even those with insurance plans may skip some necessary doctor’s appointments.
These high costs also affect healthcare providers; as avoidance of care causes patient retention rates to drop, prices must inflate to compensate for the loss of revenue.
Where do these excess costs go? Because the United States lack caps on healthcare prices, rapidly rising prices typically align with pharmaceuticals, technology use, and the middleman, or insurer. Another issue is that technology, especially procedures such as CT scans, is often used when it isn’t necessarily needed. The U.S. sees these scans ordered more often than in any other country.
There are a number of different barriers that prevent patients from seeking healthcare. One of these issues is the high deductibles they have to pay. Americans often have to meet very high deductibles before their insurance policy pays for anything. In theory, making use of these high deductibles should benefit employees and their employers, but today’s employees find themselves facing high medical bills that they simply cannot afford to pay.
This cost barrier is especially a concern to those who have chronic illnesses and require regular diagnostic tests, lab work, and medication. Some make use of credit cards, take funds from a retirement plan, or borrow money to pay for their healthcare services; others will simply skip or delay appointments, procedures, and prescription refills.
The Insurer Is Often the Problem
One of the biggest issues with healthcare cost is the insurer. The insurer plays the role of the middleman here, mediating the finances of both providers and patients. In a system ridden with increasingly costly care, providers and patients often have to select the more affordable treatment or tests over those that would be more effective. On top of a patient’s financial strain, what an insurer chooses to cover concerning tests and treatment is unfortunately variable.
The CMS and other healthcare organizations stress that no insurer should play a significant part in what options patients have or the prices they pay. Unfortunately, that’s not always the case. Insurers have the power to deny claims and may require prior authorization for tests before providing coverage; leaving patients with less control/say over both their personal and financial wellness. Insurers often look at overall patient data instead of looking at the patient as an individual when making these decisions. They also often focus on what they see as a gap in patient healthcare, seizing on that gap as a reason to deny coverage.
Another issue is the fact that many health insurance plans are offering worse coverage than they did before. This makes it very difficult for patients to receive the tests and treatment they need. Many insurers are actually exploiting holes in the Emergency Medical Treatment and Labor Act. This act states that no one can be turned away from receiving emergency treatment, even if they can’t pay. However, that cost has to be covered somewhere. Insurers shift it over to care, providers because they believe they shouldn’t be required to pay for any avoidable emergency room visit. They believe that many patients come to the ER when they could receive care elsewhere. They expect these patients to understand what requires the ER and what doesn’t.
What Solutions Are Available?
Despite the attempt to pass comprehensive health care reform through the Affordable Care Act, many patients still lack affordable coverage. There are a few things that could be done to help alleviate this issue. First, patients need help understanding the health care system. Many don’t understand what solutions are out there or how to be proactive in their health.
Another issue is to look at the free-market solution. What makes healthcare so costly? Is it possible to eliminate insurers from the model? Why do insurance plans, both those offered by employers and those purchased by individuals, so expensive?
Another option is to look at employer-sponsored healthcare. These plans serve as supplements to the insurance employers already offer. With employees capable of paying in part for their plan, employers as much as 80% of their costs, cut out the insurer and still provide their employees with access to quality care.