As money worries persist, more people put off care

Physicians are finding conversations about potential bills no longer occur just with uninsured patients. Those with health insurance are more worried about money and asking about costs of recommendations and alternatives.

“For a long time, that was the conversation I only had to have with people who didn't have insurance,” said Jeffrey Cain, MD, president of the American Academy of Family Physicians and a family physician based in Denver.

A Gallup Poll of 1,015 adults released Dec. 14, 2012, found that 32% had delayed medical care for themselves or a family member because of cost. This represented a statistically significant increase from the 30% who said this in 2008, when the recession was at its peak, and the 19% who reported the same problem in 2002.

When broken down by insured status, 55% of uninsured patients delayed care because of cost in 2012, as did 30% of those with private insurance. The results paralleled those released by Gallup on Nov. 29, 2012, which found that the proportion of people with commercial health insurance who were satisfied with out-of-pocket costs went down from 68% in 2001 to 57% in 2012.

Analysts said even insured patients are having problems paying for needed care because premiums are escalating and they are bearing much of the cost growth. A data brief issued Dec. 12, 2012, by the National Institute for Health Care Management Foundation found that the premium for a family health insurance policy grew 122% from $6,772 in 2000 to $15,022 in 2011. The employer contribution went up 114% during this period from $5,158 to $11,060. The employee portion increased 146% from $1,614 to $3,962.

“It's really getting unaffordable,” said Nancy Chockley, the foundation's president and CEO. “Health care costs are growing so much faster than real wages in this country.”

People in the health care industry said more complicated plan design is playing a role in deferring care because of cost due to the fact that patients may not understand what services can trigger an expense for them. The Affordable Care Act requires many commercial plans to cover preventive services such as cancer screenings without cost-sharing on the part of patients, but many insured still don't know this.

“There needs to be a lot more education on that,” said Jeff Wasserman, vice president of strategy and executive leadership services at Culbert Healthcare Solutions, a consultancy based in Woburn, Mass., that works with medical practices. “Patients need to be aware of what is available to them and whether or not there is a financial implication.”

The other problem, people in the health industry said, is patients know that preventive care is covered, but are electing to either forgo care or put off follow-ups because of problems found during a screening — which are not covered 100% by insurance.

Analysts are advocating that physicians stay informed about health insurance plan design and share the information with patients. Physicians also may need to be aware of free and low-cost alternatives to recommended treatments and prevention protocols.

Surveys have found that, overall, physician visits are bumping back up after declines during the 2007-09 recession and its aftermath. However, health industry experts said the Gallup numbers show that patients are still very cost-conscious when it comes to specific treatments and procedures.

“The challenge of managing health care costs is helping patients be smart consumers of health care,” Chockley said. “Physicians are in a very unique position to help people do that.”