Insured, high-income patients delay medical care, too

An examination of health care spending habits conducted by the Kaiser Family Foundation found that health care costs worry even patients with insurance and relatively high incomes. The financial worries of patients with even comfortable circumstances point to the reasons many researchers have seen a drop in patient volume at physician offices.

Patients who live on low incomes and those without health insurance are most likely to report delaying or skipping a trip to the doctor, with 81% of the uninsured reported doing so in the last 12 months, according to Kaiser’s Health Security Report, an analysis of results from a May telephone survey of 1,218 adults, 1,058 of whom revealed their income level. More than half of the insured polled — 55% — said they had delayed or skipped care in the last year. More than one in five insured adults said they had trouble paying medical bills in the last 12 months (link).

Among people whose annual incomes were $90,000 or more, 38% said they had delayed or skipped care in the last year.

“While economic challenges facing the country continue & the survey finds that the problems and concerns related to health care costs and access are widespread,” the Kaiser report said.

The skipped visits have translated into lower utilization visible to physicians and health plans during the last three to five years, and it’s unclear whether the pre-recession rates of utilization will return.A Robert Wood Johnson Foundation study released in May examining access to care for both uninsured and insured Americans found that the number of adults receiving routine checkups dropped in 37 states and by 5.1% nationally between 2000 and 2010 (link). Patient visits to doctors declined by about 4% annually from 2009 to 2011, according to the IMS Institute for Healthcare Informatics.The Kaiser survey results also are a reminder of what other research has shown — employment and insurance coverage no longer translate to protection from health care-related financial strain. Employer-sponsored coverage now offers leaner benefits at a higher price for workers, including out-of-pocket expenses that add up quickly if major illness strikes.

The Milliman Medical Index, an estimate of typical annual health care costs for an American family of four, exceeded $20,000 for the first time this year (link). The $20,728 estimate includes $12,144 in insurance costs covered by an employer and $8,584 paid by the family.

Increasingly often, employer-sponsored coverage leaves workers with a high deductible as part of a consumer-directed health plan. Those plans are credited with saving money overall, but those enrolled tend to receive less preventive care, raising the potential for long-term health and financial consequences.