Is Cost-Shifting Reducing Your Healthcare Costs in the Long-Run?

As healthcare costs continue to rise, employers shift more of the burden to their employees. In 2017, employees’ share of total costs rose 5% from $3,378 to $3,550, while employers’ share rose less than 1%, from $6,350 to $6,401 (2017 United Benefit Advisors Health Plan Survey).

Employers are also raising out-of-network deductibles and out-of-pocket maximums, and prescription drug coverage. According to a Johns Hopkins University article, “Prescription drugs are already unaffordable for many: The price tag last year in the United States was $425 billion, one out of every 10 health care dollars spent, and rising.”

Cost Shifting Could Increase Healthcare Costs in the Long Run

Research has shown that:

  • Members with high deductible health plans (HDHPs) through private insurance delay treatment and preventive care, which could result in increased emergency room utilization (Health Affairs).
  • Privately insured members with three or more chronic conditions were nearly three times as likely to delay or avoid care as those without chronic conditions (Robert Graham Center).
  • Higher Rx costs cause people to (Consumer Reports):
    • Not fill their prescriptions or not take them as directed
    • Skip doctor appointment, test, and procedures.

Distribution of Out-of-Pocket Expenses, Medical Debt, and Delay or Avoidance of Medical Care, Based on Number of Chronic Conditions, in Individuals with High-Deductible Insurance

# of Chronic Conditions * Less than $2,000 $2,000 or more Patients with medical debt ** Patients who delayed or avoided care
0 (7.812 patients) 58% 34% 28% 9%
1 (3,839 patients) 54% 41% 35% 15%
2 (1,443 patients) 51% 45% 44% 19%
3+ (573 patients) 41% 56% 52% 25%

Source: National Health Interview Survey 2012-2014 (105,779 total individuals in the study sample)

*Arthritis, asthma, coronary heart disease, diabetes mellitus, emphysema, hypertension, and stroke (excluding cancer and high cholesterol).

**Medical debt includes paying medical bills over time, problems paying medical bills, and inability to pay medical bills.

Is Your Benefits Strategy Backfiring?

If your members can’t afford to get necessary treatment or adhere to medication regimens they could be increasing your costs in the long-run through:

  • Increased emergency room visits
  • Decreased productivity
  • Increased absenteeism and presenteeism
  • Increased safety violations
  • Increased workers’ compensation or disability costs.

Do you know if your members are receiving necessary care? Can your carrier or benefits advisor readily relay that information to you? If not, you need a data analytics vendor that integrates your data across all programs and provides real-time analyses of what is happening in your population.

Sashi Segu

Sashi Segu

Sashi Segu, Counsel, has participated in cases and provided legal expertise on HIPAA, ERISA, privacy, compliance, and other healthcare-related fields. Sashi left Innovu in March 2019 to pursue other interests.

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