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ACP: Cost sharing, deductibles may force patients to delay or forego medically necessary care
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The American College of Physicians has released a position paper that outlines five recommendations for reducing health insurance cost sharing.
Deductibles, a part of cost sharing, may keep patients from the health care they need, the ACP noted in a press release.
“Underinsurance is emerging as a serious problem that may be more difficult to tackle than un-insurance,” Nitin S. Damle, MD, MS, FACP, ACP president, said in the press release. “Evidence shows that when cost sharing is imposed, consumers may respond by reducing their use of both necessary and unnecessary care.”
Nitin S. Damle
ACP reported the average annual premium for family coverage has increased by 61% from 2005 and by 27% from 2010 leading to an average of $17,545 in 2015. Employers are also moving a higher percentage of health insurance premiums to employees in the form of deductibles. The average annual deductible for single coverage rose to $1,318 in 2015 from $584 in 2005, the ACP noted. The organization noted this is particularly difficult for patients who are very sick or have low incomes.
“A different cost-sharing approach is needed to ensure that vulnerable people can afford medically necessary care in the face of rising health coverage costs and stagnant wages,” Ryan A. Crowley wrote on behalf of the Health and Public Policy Committee of the ACP.
Their recommendations address “ways cost sharing can be made more equitable in the private market by reducing overall health care spending, designing insurance plans that allow access to high-value services, enhancing financial subsidies for marketplace-based insurance plans, improving outreach and health insurance literacy and education, and advocating for updated research on the effects of patient cost sharing.”
Specifically, ACP recommends that:
- the health care system focus on ways of reducing health care spending that do not solely shift the costs on patients;
- employer-sponsored health plans should encourage high-value health care;
- that cost-sharing provisions under the Patient Protection and Affordable Care Act should be improved;
- that stakeholders promote health insurance literacy and accessible information; and
- that HHS fund a large-scale study to assess both the short- and long-term effects of cost sharing in various populations.
“An alternative approach is needed to reduce spending through systemic reform of the health-care sector, protect low-income workers from overly burdensome out-of-pocket costs, enhance subsidies for marketplace quality health programs, increase health care literacy, and direct shoppers to the right type of plan so that patients are shielded from financial ruin and insurance can function as intended,” Damle said. “ACP has provided that today with this position paper.” – by Chelsea Frajerman Pardes
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