I view the purpose of my blog as a source of scientifically valid and well-reasoned nutrition and health advice for my patients and I actively try to avoid entering discussions about health care economics and policy. But I believe the recent deterioration of health insurance benefits have crossed a critical threshold and are now a threat to the health and welfare of my patients.
January is the time of the year when changes to your health insurance benefits take effect and from what I have witnessed in the first 4 weeks of January 2010, we have just entered most potentially lethal stage of the failure of the U.S. healthcare system. We have had growing problems in the past but this is the worst I have seen in my 20 years of practicing medicine and I feel compelled to speak out.
Over the last several years there has been a steady creeping upwards in the patient’s expense for office visit and medication co-payments. These increases are purposely designed by the health insurance companies and the large self-insured employers to prevent individuals from accessing the health care system.
We have reached a new level of cost shifting that is dramatically preventing many of my patients from receiving the health care they need and deserve. Many of my patients now have to office co-payments of $40-50 per visit and a few have had co-payments as high as $85!
Their deductibles have increased to dangerously high levels as well. Many patients now have to pay all of the first $500 to $3000 of their medical expenses before their insurer even begins to pay a portion of the expense.
The ultimate effect is that my patients are less able to access medical care and this is going to have a more harmful and expensive impact down the road. Studies have show that medication co-payments as low as $10 have a detrimental effect on the health of the elderly. Other studies have demonstrated that increasing prescription drug co-payment costs can actually increase health care spending and worsen patients’ medical outcomes. A few of these studies are listed below:
- One study (NEJM 1991) compared Medicaid patients in New Hampshire “who had a three-drug limit per patient” and Medicaid patients in New Jersey without the limit. The authors found a 35% reduction in drug use, but a doubling in nursing home admission rates.
- Another (NEJM 1994) looked at individuals on psychotropic [psychiatric] medications and found that a cap on medication expenses led to a 15%-49% reduction in the use of drugs but a 43%-57% increase in mental health visits and emergency mental health services.
- A third (Am. J Man Care 1996) found that medication formulary limitations in 6 HMOs were associated with increased ER visits and hospitalizations for middle ear infections, arthritis pain, ulcers, high blood pressure and asthma.
- And finally a fourth study (NBER 2005) found that higher drug co-payments in a given year lead to increased spending during the following year.
The impact of the recent cost burden on the patients has been dramatic. Patient after patient is complaining about the cost increases and are refusing to pay or simply state they can no longer afford to come in. Many seem unaware the increases even took place. Some patients are asking I diagnose and treat over the phone or by e-mail. Some simply refuse to come in to been seen even when I tell them their condition may be serious and requires a physical examination.
I can’t fully express how badly I and my staff feel for our patients.
Because January is influenza season, we normally are so busy my staff and I barely have time to catch a quick lunch before being hit by a new wave of patients in the afternoon. But this year the office schedule remains partially empty almost every day. Patients are rationing their visits to the doctors office due to the financial burden our patients now face when deciding to be seen.
Now many patients will eventually recover from whatever ailment they may of needed to see me for. Sinus infections eventually resolve (although it may take 4-8 weeks), back strain will slowly go away (you might miss a few more work days without treatment) and most mild headaches, rashes or vague symptoms may simple resolve on their own without any great risk to a person’s life or limb.
But these are often questions that at times patients prefer to have their primary care physician help them answer. The conditions I sited above are relatively harmless, inconvenient conditions but there are other conditions in which a delay could result in a catastrophic outcome.
As an Internal Medicine specialist, I have a high proportion of patients with very serious medical conditions such as diabetes, heart disease, high blood pressure, asthma and HIV Disease. Many of these patients are trying “ride out” their problems at home and are putting themselves in great jeopardy. I’ve had several sent to the emergency room straight from my office recently because they had waited so long before coming to be seen it was dangerous to try to treat them in my office.
I recently had an HIV patient hospitalized with a dangerous spinal fluid infection because he could no longer afford the co-payments for his HIV medications. I am afraid it’s only a matter of time before one of my patients dies needlessly because they can no longer access their medical care.
I don’t have the expertise to know how to fix the health care system but I do know one thing, we need to be more vocal about the negative consequences these rising health costs are having on our friends and family. Since your employer actually decides what benefits are going to be included in your health insurance, we need to tell them their decisions are our friends and families health at risk. Contact your government representatives and tell them we do not have time for partisan bickering.
The health care train is coming off the tracks folks and I am afraid some of my patients will be permanently injured or die because of the financial barriers placed between them and the health care they require and deserve.