Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures

Abstract

PURPOSE Out-of-pocket cost sharing for health care expenses is a growing burden. Prior research has emphasized the medical consequences of cost sharing. This study investigates the range of social, medical, fi nancial, and sometimes legal disruptions from high out-of-pocket health expenses.METHODS We conducted open-ended, semistructured interviews with 33 insured patients (two-thirds covered by Medicare). All had chronic illnesses and sought philanthropic fi nancial assistance. RESULTSWe found that high levels of cost sharing precipitated considerable anxiety and substantial debt problems, as well as disruptions of medical care. Participants described various borrowing strategies (eg, credit cards), legal problems (eg, debt collections), and threats to their nonmedical household budgets (eg, food, housing). Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benefi ts with exceptional detail but described considerable anxiety about changes to those benefi ts that could easily disrupt carefully managed household budgets. Benefi t designs that resulted in large a variations in fi nancial liability from month to month (eg, large deductibles or coverage gaps) imposed considerable fi nancial challenges.CONCLUSIONS As health care cost sharing grows, policy makers will need to consider the consequences of high cost sharing for families facing strained household budgets. Although the generosity of health insurance is important, continuity of benefi ts and month-to-month stability of fi nancial liability are also important and may be undervalued in policy discussions. Ann Fam Med 2013;11:37-42. doi:10.1370/afm.1444. INTRODUCTIONA merican families are contributing a growing fraction of their personal income to health care. [1][2][3] From 1999 to 2007, health insurance premiums increased more than 4 times faster than wages. 4,5 Benefi ts also have become less comprehensive. 1,4,[6][7][8] These cost pressures lead families to make fi nancial trade-offs within their household budgets in response to health care needs. Little is known about the choices families make and how they make them. In this study, we investigate the range of social, medical, fi nancial, and sometimes legal disruptions from high out-of-pocket health expenses. We refer to these broad effects as life disruptions.The literature examining fi nancial burden from health care focuses on 2 major areas. First, several studies have examined trends in the numbers of individuals and families facing a great fi nancial burden from health care. These studies generally have shown that a large and growing percentage of Americans are experiencing fi nancial challenges attributable to health care. 1,2,7,9 Second, other studies have examined the extent to which high levels of cost sharing and fi nancial burdens translate into decreased use of 38 LIFE DISRUP T IONS FRO M HIGH HE A LT H E X PENDIT UR ESnecessary health services, such as ambulatory visits or prescription drugs. [10][11...

Chronic Conditions, Medical Out‐of‐Pocket Expenditure Burden, and Perceived Health

“…One possible explanation is that high medical bills have been found to drive consumers to risky coping strategies. Some consumers may compromise treatment by not adhering to prescribed dosage levels of medications or they postpone or ignore seeking treatment that can affect their health outcomes (Grande, Barg, Johnson, & Cannuscio, 2013). A significant positive relationship was found between adverse financial circumstances and poor self-rated health in 1,506 emergency room patients (Bisgaier & Rhodes, 2011).…”

“…One possible explanation is that high medical bills have been found to drive consumers to risky coping strategies. Some consumers may compromise treatment by not adhering to prescribed dosage levels of medications or they postpone or ignore seeking treatment that can affect their health outcomes (Grande, Barg, Johnson, & Cannuscio, ).…”

An application of ARIMA model for predicting total health expenditure in China from 1978-2022

“…Equity in health financing is not only related to the amount of THE, but also the structure among the three components [4]. Increasing the proportion of OOP may cause people to forgo care and become poor [5][6][7]. In 2010, OOP pushed an estimated 97 million people (1.4% of the world' s population) below the US$ 1.90 per day extreme poverty line [8].…”

Sticker Shock: The Experience of a Health Care Consumer

“…For many patients, the quirks in pricing we experienced can lead to unpaid medical debt and financial distress with profound consequences. 4,5 Moving forward, insurers need to focus on reducing price variation. Primary care physicians may have to play a larger role in helping patients navigate prices.…”