High deductibles scaring patients away from care

For several years now, rising out-of-pocket health costs have caused some patients to forego needed care. A recent study from the Commonwealth Fund confirms that not only are patients cutting back on care due to cost, but also their misunderstanding of insurance coverage leads many to forego preventive care unnecessarily.

Highlights from the national survey of 2,751 adults ages 19 to 64 conducted this fall include the following:

  • Overall, 43 percent of respondents said it was either somewhat or very difficult or impossible to afford their deductibles, which have on average more than doubled since 2006. Low- to moderate-income individuals (64 percent and 58 percent, respectively) reported this problem at roughly twice the rate of those with higher incomes (27 percent).
  • Thirteen percent of those surveyed had deductibles equal to 5 percent or more of their incomes. Among those, 40 percent said they had not seen a doctor when they were sick, did not get a preventive care test, skipped a recommended follow-up test or did not get needed care from a specialist. Results were similar even among respondents with deductibles comprising less of their income.
  • Copays and coinsurance represented less of a burden than deductibles, but still affected care decisions particularly among those with lower incomes. Forty-six percent of insured adults with incomes under 200 percent of the poverty level said that because of copayments or coinsurance, they had either not filled a prescription, not gone to the doctor when they were sick, skipped a medical test or follow-up visit, or not followed through on a referral to a specialist, according to the report.

Sara Collins, Ph.D., a Commonwealth Fund vice president and the study's lead author, told Medical Economics she found the results concerning. "Avoiding preventive care tests could result in development of more serious and costly conditions that may be treated early at lower cost," Collins said. "But what is also concerning is that deductibles by law exclude preventive tests. So this shows that the complexities of cost sharing create confusion for consumers and may lead to delays or avoidance of needed care." 

To learn more:
- read the Medical Economics article
- see the issue brief
- read the announcement