ACP offers solutions to problem of increased cost sharing for patients
Among other positions, ACP says that the health care system must accelerate its efforts to reduce overall health care spending in ways that do not rely principally on shifting the cost burden onto insured persons who cannot afford to pay more for their medical care.
Cost sharing, especially deductibles, may make patients forgo or delay even medically necessary care, according to a new position paper from the American College of Physicians.
Although fewer Americans are now uninsured, mainly due to the Affordable Care Act, “underinsurance” remains a problem as deductibles, co-insurance, and copayments have become more common, according to the position paper. “Although cost sharing may be an effective tool to curb unnecessary health care use, it also may cause some enrollees, especially those with lower incomes, to forgo necessary services,” the author wrote. “Generally, higher cost sharing may not have negative consequences for healthy enrollees but is associated with adverse health outcomes among vulnerable populations, including individuals with a low income, poor health, or chronic illness, or those who are elderly.”
The position paper offers the following recommendations on making cost sharing more equitable in the private market:
1. To help contain health insurance premiums and cost sharing, the health care system must accelerate its efforts to reduce overall health care spending in ways that do not rely principally on shifting the cost burden onto insured persons who cannot afford to pay more for their medical care.
2. To encourage use of high-value health care, employer-sponsored health plans should:
- Consider implementing value-based insurance design strategies that reduce or eliminate out-of-pocket contributions for services proven to offer the greatest comparative benefit, with higher cost sharing for services with less comparative benefit. Such strategies should be based on rigorous comparative effectiveness research by independent and trusted entities that do not have a financial interest in the results of the research. The goal should be to ensure that high-value cost-sharing strategies encourage enrollees to seek items and services proven to be of exceptional quality and effectiveness and not just on the basis of low cost;
- Consider implementing income-adjusted cost-sharing approaches that reduce or directly subsidize the expected out-of-pocket contribution of lower-income workers to avoid creating a barrier to their obtaining needed care.
3. Cost-sharing provisions under the Patient Protection and Affordable Care Act should be improved by expanding eligibility for qualified health plan premium tax credits and cost-sharing subsidies for families and enhancing the affordability of marketplace-based qualified health plans.
4. Stakeholders must work together to enhance health insurance literacy and promote better, more accessible, and objective information about cost-sharing requirements and health insurance plan design.
5. A large-scale demonstration should be implemented to test the short- and long-term effects of cost sharing in different populations.
The position paper was released July 13 and is available online.