Increased cost-sharing, particularly high deductibles, lead patients to neglect necessary healthcare, according to a position paper from the American College of Physicians (ACP).
“The effects are particularly pronounced among those with low incomes and the very sick,” said Nitin S. Damle, M.D., president of the ACP in an announcement that accompanied the paper.
By exposing individuals to the full cost of certain expenses, cost-sharing undermines the primary function of insurance, says the ACP, noting that underinsurance may be a more challenging problem than lack of insurance.
More than 40 percent of marketplace plan enrollees and more than 20 percent of those insured through employers who report being in fair or poor health or having a chronic condition express confidence that they can afford necessary care, the paper says. But those with high-deductible plans have less confidence in their ability to afford a serious illness than those with low-deductible plans.
The ACP notes that rising premiums have led many employers to shift costs to employees in the form of higher average deductibles, which more than doubled between 2005 and 2015, even as wages remained largely flat.
Plans available through the health insurance marketplaces often have even higher deductibles and co-pays that employer plans, the paper says--though a new report from the federal government argues that the availability of financial assistance makes deductibles lower than some think for many exchange plans.
The paper recommends several changes to ensure vulnerable populations can afford the care they need. They include:
- Accelerate efforts to reduce overall healthcare spending without relying on shifting costs to patients through higher premiums and cost-sharing
- Reduce or eliminate out-of-pocket contributions for services shown to have the greatest benefit, and increase costs for those that have less effectiveness, as determined by independent entities
- Subsidize out-of-pocket contributions on an income-adjusted basis
- Revise cost-sharing provisions in the Affordable Care Act
- Provide accessible and objective information about plan design and cost-sharing requirements so consumers can effectively weigh their choices
- Test the impact of cost-sharing in a large-scale demonstration