Cost-Shifting Burden Falls Unevenly on Sickest

Who gets hurt most from increases in patient cost sharing? According to a study from the Center for Studying Health System Change (HSC), “increased patient cost-sharing raises out-of-pocket costs more for people with chronic conditions, those in poor health, and people with at least one hospitalization.”

Sally Trude, author of “Patient Cost Sharing: How Much Is Too Much?,” wrote that cost-shifting to employees can occur in two main ways: increasing the percentage of the total premium that they pay or mandating higher deductibles, copayments, and coinsurance. Employers primarily have opted for the latter method.

The researchers expect that a “significant increase in out-of-pocket costs would moderate use of health care services,” according to Trude.

HSC used actuarial models to estimate patients’ expected average annual out-of-pocket costs for different benefit structures. Those structures range from option 1, in which a patient pays a copayment of $10 for primary care and specialist visits and no deductible, to option 6, which has a $2,500 deductible with 30 percent coinsurance for in-network care and 50 percent coinsurance for out-of-network care.

Researchers calculated, by health status and benefit scenario, the likelihood that out-of-pocket costs would exceed 10 percent of an employee’s income.

One percent of employees with chronic conditions under option 1 (lowest cost sharing) were projected to spend more than 10 percent of their income on out-of-pocket health care costs; however, 22 percent of employees with chronic conditions under option 6 (highest cost sharing) were projected to spend more than 10 percent of their income on out-of-pocket health care costs.

Fifty-three percent of employees in poor health under option 6 were projected to spend more than 10 percent of their income on out-of-pocket costs, while only 5 percent of those in poor health would do so under option 1.

Trude pointed out that nearly half of all personal bankruptcies are due in part to medical expenses.

“Patient Cost Sharing: How Much Is Too Much?” is posted online at www.hschange.org/CONTENT/630/. ▪