Would you skip an important medical treatment because it costs too much?
Apparently, a sizable proportion of people in the United States are doing just that.
Despite reforms to our health insurance system, medical care remains unaffordable for many Americans, according to a recent survey by the Physicians Foundation.
More than a quarter of U.S. adults questioned earlier this year say they have skipped a medical test, treatment or follow-up care, or avoided a visit to the doctor for a medical problem during the previous 12 months due to cost.
“I see this commonly in my practice,” said Dr. Ripley Hollister, a family medicine specialist in Colorado and a board member of the Physicians Foundation. “It takes many forms and many times the results can be disastrous.”
The study included responses from 1,511 U.S. adults between the ages of 27 and 75 who had two visits with the same doctor in the past year.
Hollister said that one of the most worrisome types of incidents occur when he prescribes an antibiotic a patient needs immediately, but when the patient gets to the pharmacy the pharmacist says the prescribed medicine is not covered by the individual’s insurance plan.
“Another common issue is when the cost of medicine becomes too high, a patient simply stops taking it or they may stop taking it as directed,” Hollister told Healthline.
He explained that some patients might take medicine only every other day instead of daily or they cut doses in half.
The survey results indicated that 18 percent of those polled have skipped doses of medicine and 27 percent have avoided filling a prescription due to cost.
“I have seen unnecessary morbidity, emergency room visits, hospitalizations, operations, dialysis, and heart catheterization occur from the cost barriers to appropriate adherence to a good care plan,” Hollister said.
He added whenever a chronic condition gets out of control and becomes an acute, urgent issue, unnecessary costs are generated.
Worries About Treatment Costs
To compound problems, 62 percent of survey respondents said they were concerned about being able to pay for medical treatment if they get sick or are injured.
About 48 percent are not confident that they could afford care if they become seriously ill. That number rises to 64 percent when considering only those who are uninsured.
These concerns appear to be realistic, as 43 percent of survey participants said they had an unexpected healthcare expense during the past 12 months. For 63 percent of them, it caused serious financial hardship.
Furthermore, 40 percent reported that they have debt due to medical expenses.
“Advances in medicine are huge,” said Hollister. “They really come with a big price tag.”
Laurence C. Baker, Ph.D., professor and chair of the department of Health Research and Policy at Stanford University School of Medicine, concurs.
“These issues are ultimately symptoms of the high costs that pervade our healthcare system,” he told Healthline. “We’ve built for ourselves a very expensive system and seeing that makes people understandably concerned about how we will all pay the bill for these services. Addressing these challenges will fundamentally require serious efforts to contain cost growth, which will ultimately affect all of us.”
Insurance Not Always the Answer
Insurance doesn’t appear to always fix these cost problems.
According to the survey, one-third of those who purchased health insurance feel that the premium is unaffordable. Among those with a deductible, 39 percent say they can’t afford the cost.
Additionally, 21 percent believe their primary care physician copay is unaffordable, which jumps to 57 percent for specialist copays.
This lack of affordability is more pervasive among those with employer-sponsored coverage or those who purchase insurance on their own compared with those covered by Medicare or Medicaid.
“For some patients, particularly those who remain uninsured or who are in health plans with high deductibles or copayments, costs of medical care can still be a burden,” Baker said. “Some people do, unfortunately, find themselves in the position of foregoing medical care because of costs.”
However, Baker said that there have been important positive changes in access to care and affordability of care over the past couple of years and dramatic reductions in the number of people who are uninsured.
“The Affordable Care Act has also done a lot to make insurance more affordable for many people in the country,” he said.
Nevertheless, he noted that insurance costs for some people could still be quite high relative to their income.
“The Affordable Care Act subsidies and the Medicaid expansion have helped many lower income people, but in some states that have not expanded Medicaid, there can be very low income families for whom insurance is very difficult to afford,” Baker said. “And even some middle income families, for whom the ACA may provide very limited or no assistance, can find it a challenge.”