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Health care cannot afford uninformed, cost-conscious public: study

by Gus Iversen, Editor in Chief | January 22, 2015
One in five insured Americans have avoided visiting a doctor within the past 12 months due to cost concerns. Two out of five do not have a good understanding of which health care services are covered under their current plan. And for 60 percent of the U.S. population, health reform in general has left them as confused as ever about their health care system.

These were the findings of a SCIO Health Analytics study released today.

Perhaps most disconcerting: about 14 percent of patients with chronic conditions, (over half of U.S. adults have chronic conditions) are neglecting their care due to cost concerns and lack of cost awareness. Total treatment costs for those Americans already come in around $277 billion annually, and that number only goes up when they neglect their recommended screenings and suddenly wind up in the ER.

"The cost of treatment for a chronic patient is about $2,800 or so, but if they wind up in the ER that cost rises to something like $15,000," said Siva Namasivayam, CEO of SCIO Health Analytics, on the phone with DOTmed.

The researchers behind the study were less interested in figuring out if people were going to their personal care providers (PCPs) than they were in figuring out what factors lead to negligence. Looking at chronic condition patients, some patterns emerged.

"Many of them had a high-school-level education, no full-time employment, income lower than the national average, and resided in the South," said Lalithya Yerramilli, director of health care analytics at SCIO, on the phone with DOTmed News.

They also found that 70 percent of the patients skipping chronic condition check-ups have smartphones. "Rather than wait for them to log into a portal, maybe it's better to reach out to them via text message," suggested Yerramilli.

The problem is compounded by the fact that many patients in the ER do not wind up being accountable for those emergency expenses. Instead, those costs are absorbed by the treating facility and the health care industry.

"From a patient standpoint it almost makes sense to hold out for the ER, at least from a financial perspective," said Namasivayam. "They are making a short term month-to-month tactical decision and, for health, you simply cannot do that."

That type of unaccountability may promote thinking in which a patient chooses to let his health slide because that bill – although several times larger than the one they would get at the PCP – might not land on them.

"It creates more long-term issues if they wind up in the ER than if they go to the PCP," said Namasivayam. "The plans should clearly talk about how they will pay more at the ER."

The study did not take into account different insurers and the levels of understanding members had from one provider to another.

Namasivayam and Yerramilli hope that by understanding the drivers of this behavior, they can use data and analytics to address the problem. Yerramilli stressed that resolving the situation starts with reaching out to these patients and educating them.

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