A year ago, a woman in severe abdominal pain arrived at my emergency department. She had gallstones and knew she needed surgery. However, due to her family’s unmet insurance deductible, she hesitated to seek help. By the time she came to us, her condition was critical. A gallstone had obstructed a duct, leading to a serious condition called necrotizing pancreatitis. She spent two weeks in intensive care and underwent three surgeries, racking up bills that far surpassed her deductible.
Months later, our hospital switched to high-deductible health plans (HDHPs), and I felt the impact. I had to ask my doctor for a cheaper, less effective medication because I was worried about costs. A colleague left for a job with better insurance after her heart medication became too expensive, while another searched for the cheapest MRI after experiencing hearing loss.
Even full-time doctors in our system now face $3,000 deductibles. We diagnose conditions late because many patients delay care, worrying about cost.
So, why are HDHPs so common? According to a survey from the Kaiser Family Foundation, over a third of Americans in private-sector jobs have these plans. Introduced in the early 2000s, HDHPs were intended to reduce healthcare costs by promoting consumerism. The idea was that if people had to pay more out-of-pocket, they’d shop around for better prices. However, the reality is quite different.
Research from Health Affairs and JAMA shows that while patients spend less, it isn’t due to smart shopping. Instead, they avoid necessary care, leading to worse outcomes. Patients skip preventive checkups, and emergency visits increase due to delayed treatment. For example, patients avoid getting gallbladder surgeries or necessary medications, leading to complications that could have been managed earlier.
This approach is alarming. Even doctors are affected; they now have to weigh the cost of their own health needs. The very professionals who promote early intervention often end up postponing their own care, which contradicts the goals of value-based care.
To truly improve healthcare in the U.S., we need to rethink our system. First-dollar coverage for primary care and essential services should be available, along with affordable options for catastrophic care. Deductibles could be income-based, as health issues don’t discriminate by when they occur.
Amy Caggiula, an expert in emergency medicine, emphasizes the importance of advocating for both patients and healthcare workers. In any other industry, a model that thrives when consumers avoid using services would be questionable. Sustainable healthcare needs a structure that encourages access and affordability, not one that puts financial barriers in the way of care.
Ultimately, a better system starts with understanding that high-deductible plans may result in sicker patients who cannot afford timely care. We owe it to ourselves—and each other—to demand a fairer, more effective healthcare model.
Source link
drug pricing,Health insurance,Physicians,public health,research
