We hear you loud and clear. We feel it ourselves. Health care costs too much. Not only are most of us paying a monthly premium...but in addition to that, most of us are also paying a co-pay, which is a set amount paid for each type of visit (for example $20 for primary care office, $40 for specialist, $250 for ER), or co-insurance which is a percentage of the total cost of care (20%, 30% for example), or a deductible which can be thousands of dollars out-of-pocket before our insurance company pays a dime.
No matter how you slice it, most Coloradans are feeling some of the pain points associated with our current health care system and the direction that the future health care system will take is still a big question mark. Just to check out the current health plan marketplace, I searched for a health plan for my family of 2 adults and 3 children and came out with monthly premiums ranging from a little over $1000 up to $1700+ associated with either 20-30% co-insurance or thousands of dollars per year in out-of-pocket deductibles before insurance pays for care. This is still right about where my current high-deductible health plan is with $1300+ per month premiums and $6000+ per year in out-of-pocket expenses.
While there is little consolation in the misery of others, you definitely are not alone in feeling the pain of costs. In the State of Colorado, newly released data from the 2017 Colorado Health Access Survey conducted by the Colorado Health Institute shows that in certain parts of the state, as many as 1 in 4 patients state that they have skipped needed care in the past year because of the cost associated with it. While insurers may not mind that they are getting paid premiums, yet patients are not accessing the care they need...there are some potential seriously negative outcomes that may arise from not obtaining care when needed. We may not realize for another decade or more what the eventual health fallout will be from all of these high-deductible health plans and other cost burdens that are preventing people from getting the care they need. Skipping an X-ray today because of cost, may result in an undetected lung cancer which when not caught soon enough may result not only in increased costs down the road, but obviously the unfortunate potential reality of a life shortened.
This study shows that on average about 10% of people are skipping doctors appointments, 10% are skipping getting their prescriptions, and about 11% are skipping specialist care. Overall, about 20% of all Coloradans say that cost is a barrier to accessing the care they need. High prices create a much tougher burden on those in the lower income brackets where many are spending more than 20% of their take home income on health care costs. This leaves little for all of the other basic necessities needed for themselves and their families.
The problem is bad enough for about 750,000 of our residents that in addition to tapping whatever savings they may have, they have resorted to taking on credit card debt, not paying for basic necessities like food, heat or rent, working additional hours or jobs, taking out a loan, and even declaring bankruptcy. Most people want to do what is right when is comes to being responsible and that includes making sure the bills are paid. It is unfortunate that many have to resort to these measures just to cover the expenses of getting medical care.
If health care was more affordable and easier to access, many of us would likely take better care of ourselves when needed. While there is a portion of people who will not seek out help, even when sick, those that do seek out medical care often run into barriers to obtaining that care. These barriers appear to be higher for those on Medicaid compared to those on employer-sponsored or private insurance plans. According to the Health Access Survey, of multiple choices, the reasons for not being able to access care when needed included:
Not being able to get an appointment as soon as felt needed was the highest ranked reason for not obtaining care, but even of those that did access necessary care, 72.5% of Coloradans reported they could not get into a general doctor as soon as they felt they needed to. Going along with this finding is another survey of physician appointment wait times conducted earlier in the year by Merritt Hawkins which put the average wait time to get a new patient appointment with a family medicine physician at 27 days in Denver. While the actual average wait time was significantly different between these two surveys, the overall result was the same: patients cannot access a doctor as soon as they feel they need to. This will likely either result in skipping care or in utilizing more on-demand high cost resources such as Urgent Care Centers and Emergency Departments.
Speaking of high-cost resources, let's talk about Emergency Department use. Going to the Emergency Room for even the most minor of issues will cost hundreds of dollars. ER visit charges are generally broken down into five categories which are meant to correlate with the complexity of the medical situation and the resources used. Using the cost transparency promoting website healthcarebluebook.com, even the lowest possible charge bracket will run in the $600+ range. This generally will be for an extremely brief visit in which no other testing is done. Nationally, less than 3% of patients are charged this lowest level charge and most, even those with minor issues, are charged the higher cost visit codes. Locally, the next bracket runs about $1300. $1300+ for a sore throat! Don't doubt it. It is actually more likely than not.
Since 2009, when the first Colorado Health Access Survey was conducted, the number of Colorado residents using the Emergency Room has not changed much. Consistently about 20% of residents use the ER each year. What is notable is that when broken down by insurance type(or lack of), 36.5% of Medicaid enrollees used the ER in the past year while only 10.9% of the uninsured did. This indicates that for some reason Medicaid patients are over-using the Emergency Room as their source of care while the uninsured, who actually have limited care options are not. The reasoning behind this is beyond the scope of this writing, but addressing the Medicaid over-utilization would be a step in the right direction of providing the right level of care at the right price.
Even though it is slightly down from the prior survey, still almost 40% of patients admit to going to the Emergency Room for known non-emergencies. Obviously, if a patient knows they are not having an emergency, why would they feel it is necessary to go to an Emergency Room? Among many of my physician colleagues, one hypothesis among the Medicaid population is that there are almost no negative consequences for doing so. Their "copay" for ER use is extremely low yet the services rendered are generally very high.
But the Medicaid patients are only a subset of the non-emergency Emergency Room users. When the Health Access Survey asked all of those that went for non-emergency reasons what those reasons were, these were some of the selections they made(they could choose more than one):
Based on these selected results mentioned in this article, we see several overarching scenarios emerging:
While we have made great strides over the past several years in getting more people insured, access and cost remain a significant stumbling block for many of us. There are several organizations working on ways to alleviate some of the pain, generally within specific geographic locations or within specific communities. But an answer that can be applied state-wide which is insurance and health care system agnostic is still elusive.
One way to address nearly all of the issues mentioned in this article, is to increase the well-designed use of and education about telemedicine. Providing a no appointment needed, convenient, cost-controlled alternative to expensive care options which can be available to patients after-hours and weekends can help increase access to care yet manage costs. With insurance reimbursement policy changes that have taken place in this state for private insurers and Medicaid, and hopefully a Medicare change coming in the near future, we can open up care availability and likely decrease appointment wait times as one of the biggest reported reasons that patients feel they cannot get the care they need and also for why they are using the ER for non-emergencies.
Many unnecessary office, urgent care, and ER visits can be diverted to a convenient low-cost telemedicine visit. Local Colorado-based telemedicine service providers such as Care on Location and Hippo Health are able to provide high-quality care from board-certified physicians from the convenience of a patient's home or hotel anywhere in the state of Colorado at a fraction of the cost of an ER visit. On the patient side, this means less hassle, fewer transportation issues, less of missing work, and less need to try and find child or elder care. All of this helps ease the life and financial burden of obtaining care in what we believe will be a new telemedicine-first model of healthcare. If further in-person care is needed than a telemedicine visit, the most appropriate and cost-effective method of further care can be coordinated through a connected web of communicating health care resources.
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