Health insurance is not enough to provide affordable access to needed care for America’s most vulnerable, according to a new PhRMA report.
For too many Americans, insurance coverage does not provide the health security it is supposed to.
Pharmaceutical Research and Manufacturers of America (PhRMA) ‘s first Patient Experience Survey (PES) found that three in ten people with medical insurance still face financial barriers to accessing health care and healthcare. prescription drugs.
This leads to poor membership and deteriorating results according to Stephen Ubl, president and CEO of the organization.
The in-depth survey of nearly 5,000 people, including more than 3,500 who depend on prescription drugs, suggests that “insurance policies and practices create barriers to life-saving care” with “devastating results”
“These include worse patient health outcomes and higher costs across the healthcare system,” he said, adding that the system was not working for the “sickest and most sick. most vulnerable ”in society.
Launched in the wake of the COVID-19 pandemic, the PES was designed to explore common barriers to accessing healthcare and prescription drugs in the United States.
“This insecurity in access to health care disproportionately affects those with the poorest health, people with disabilities and patients with the most serious health problems.”
It aims to understand how patients engage with the healthcare system, uncover the challenges Americans face in access and affordability, and identify solutions.
This initial work revealed that while 70% of people were satisfied with the ease with which they could access the care they needed, this was certainly not the case for everyone.
Thirteen percent said they had to forgo the care they needed, struggled to pay their medical bills, had out-of-pocket expenses they couldn’t afford, or had no savings to cover medical expenses.
“This insecurity in accessing health care disproportionately affects those who report poor health, people with disabilities and patients with the most serious health problems,” the report said.
It is important to note that these “systematic challenges” are not limited to the uninsured. In fact, almost a third of those insured, 30%, said they could not pay medical bills or out of pocket expenses.
Americans spent an average of $ 1,568 on health care costs over the past year, but 44% of respondents had less than $ 1,000 in savings to pay for urgent or unforeseen expenses.
Poor adhesion, bad results
Unaffordable reimbursable fees are “strongly correlated with prescription abandonment,” the report warns.
The survey found that 52% of patients who take prescription drugs and have a high-deductible health plan reported at least one episode of non-adherence in the past year. This figure rose to 87% among those who had accumulated medical debts.
“Predictably, Americans who forgo strict adherence to their prescription drugs face health problems. Half, 48%, of all those who report one or more episodes of non-compliance report that their health has suffered. This number rises to 82% of patients with infectious disease, ”the report said.
The survey also shows how health plan utilization management tools create significant barriers that disproportionately impact the sick and vulnerable.
“Health insurers use usage management tools to determine when and how a patient can access a particular drug, through methods such as pre-authorization and step therapy,” the report explains.
“These additional barriers to accessing prescription drugs can cause delays, prevent patients from collecting their prescriptions, or force patients to take alternative medicine (which is) preferred by the insurance company.”
Crucially, these barriers disproportionately affect those patients who have the most concerns about accessing and purchasing their care.
Seven in ten, 68%, of those who said they were “very worried” about getting the care they need and getting the care they need reported barriers to managing the problem. use, compared to only 38% of the rest of the population.
Patients with chronic conditions, such as autoimmune diseases, allergies, and diabetes, were more likely to report use management experiences than those taking prescription drugs for other conditions.
In addition, 56% of Black Americans and 60% of Hispanics surveyed were subject to use management practices, compared to just 36% of White Americans.
“The data reveals that the design of health insurance benefits – including out-of-pocket expenses not covered by insurance and utilization management practices – contributes to insecurity of access to health care and may lead to poor health outcomes, ”the authors state.
The report notes that access and affordability issues are “largely due to the deterioration of health insurance coverage,” and calls on the industry to make changes that take into account “the entire healthcare landscape. health care and patient experience ”.
“The policy solutions Americans like tend to focus on demystifying their coverage – promoting transparency and predictability – and reducing their out-of-pocket expenses. “
This could include limiting personal expenses to a certain percentage of household income, making it easier to find and understand cost estimates before starting treatment and providing a fixed co-payment instead of a coinsurance. , for example.
Interestingly, survey respondents said they would prefer lower out-of-pocket expenses to lower health insurance premiums.
It is time, the report says, to make a change.
“The current healthcare debate is missing reforms that will help address the structural problems that many patients say they face in the healthcare system today.
“This survey shows that policymakers should focus on the real problems faced by patients, offering solutions that correct inequalities in health care, reduce out-of-pocket costs and remove barriers to care,” Ubl said. .
About the Author
Amanda Barrell is a journalist, writer and freelance writer in health and medical education. She has worked on projects for pharmaceutical companies, charities and agencies, and has written extensively for patients, healthcare professionals and the public.