Health insurance is meant to protect patients from the burden of high health care costs, but a new survey suggests that for many seriously ill patients, insurance doesn't provide enough financial protection, Margot Sanger-Katz writes for the New York Times' "The Upshot."
The survey was conducted and analyzed by the New York Times, the Commonwealth Fund, and the Harvard T.H. Chan School of Public Health. It included responses from 1,495 adults who either had been seriously ill in the past two years or were caring for someone with a serious illness. The researchers defined "seriously ill" as being hospitalized at least twice in the past two years and seen by at least three doctors.
This population of patients "may serve as an early warning system" for the broader health care system, Sanger-Katz wrote. She explained, "Because the estimated 40 million people in this population visit doctors, hospitals, nursing homes and pharmacies the most, they are the likeliest to see the weak points in the health care system."
When health insurance is not enough
Among the respondents who had health insurance, 36% said they had used up most or all of their savings to pay for their health care, while 29% had been contacted by a collection agency, and 21% were unable to pay for basic necessities, such as food, heat, or housing.
Tristan Berger, 47, who has spina bifida and who suffered a series of falls that left him too disabled to continue working, said last year he spent $12,000 on care not covered by his insurance. He said, "You sit there every month trying to figure out what bill to pay: Do you pay the hospital bill or do you pay the utility bill?"
The good news is that insurance did at least mitigate the risk of disastrous financial consequences, Sanger-Katz writes. Uninsured respondents were even more likely than insured respondents to report having used up most or all of their savings to pay for their care.
But even insured patients reported widespread confusion about their coverage. Nearly a third of the respondents said they weren't sure what their health insurance would pay for, and more than two-thirds said their doctors had not discussed the cost of their care with them. Similarly, 42% said they had received a hospital bill not fully covered by their insurance, and 26% said a treatment recommended by their doctor had been denied by their insurance.
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In addition, the survey found that financial burdens affected others beyond the individual patient. Nearly a quarter of the respondents said a friend or family member caring for them had faced financial strain as a result of the patient's illness, and 15% said their caretakers had to quit or change their jobs.
Sarah Miller, an assistant professor at the University of Michigan Ross School of Business, said research shows coverage improves patient's financial outcomes, but it's not always enough to make costs bearable for complex care patients. "You're kind of at a disadvantage as a consumer going against these big complicated systems that don't always have your best interest at heart," she said. "And I think that's why there's so much financial burden, even among people with private insurance."
Robert Blendon, a professor at Harvard University who helped design the survey, said the most striking finding is that "there's no way people could know what they would be in for." He added, "They don't know what their insurance covers. The consequences for people are quite extraordinary."
But some providers are taking note and are beginning to integrate cost conversations into their patient visits. Khurram Nasir, an associate professor of medicine at Yale University, said that when he noticed many of his cardiac patients were struggling to pay for their care, "I took it upon myself as a responsibility to talk to my patients about these issues. It was very hard for patients to bring this topic to our attention" (Sanger-Katz, "The Upshot," New York Times, 10/17).
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