Friday, December 19, 2008

Healthcare cost-sharing contributes to morbidity and death

I came across an article published in The American Prospect Online via AlterNet. The article is entitled “Lessons from the ER” and it relates the author’s thoughts about his wife’s recent healthcare system experience. I wanted to highlight one part of the article that is certainly not the only point of the article, but it caught my eye because it relates to a recent discussion I had. I recommend you read the whole article.

First to throw out a teaser for the article as a whole:
Several people made mistakes in Veronica’s care. The worst and most deadly mistake was ours: going to this urgent-care center.

Do read the whole article (link above).

To the point I wanted to draw out here. Part of the reason that they went to the urgent care center was consideration of their co-pay and deductible. The author mentions a RAND study from 25 years ago that resulted in the nearly universal insurance feature of the co-pay. The study’s
most potent finding was that people who got free care used 40% more services than did others assigned to cost-sharing plans. Yet the free care produced little measurable additional benefit for the average patient.

From this co-pay and deductibles grew and flourished
To discourage inappropriate care

However, you really need to key in on the “average patient” phrase and wonder for which patients there was “additional benefit” and is there a way to separate them from the group to ensure maximum benefit for each individual patient. Did “overutilization” save a life or cut down on morbidity for some individual?

The author goes on about the study:
Co-payments did discourage wasteful use…relatively non-urgent categories such as sprains and back pain were 47% less frequent in cost-sharing plans [hopefully not an aneurysm causing the “non-urgent” back pain]. Unfortunately, co-payments also discouraged appropriate use…Most patients cannot reliably distinguish appropriate from inappropriate ER use [particularly at the time of the pain/symptom]…

Co-payments and other cost-sharing, which insurance companies and purchasers of insurance are pushing to new highs, can and do contribute to health crises and, even, death. This “remedy” for rising health insurance premium costs is a failure and worse, can be a cause of death. Our current system needs an overhaul at least or replacement with something better for all concerned.

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