Impact Of Cost Sharing At High Deductible Health Plans On Health Service Utilization

Health insurance comes as second nature to many of us. We grab that blue and white card and put it in our wallet and forget about it until we are sick or injured. When this happens, there it is, cushioning our fall like the extra padding it provided to cushion our wallets. This is not the case with everyone, however. Many Americans have no cushion to fall back on, no blue and white card to show the emergency room when they have an unexpected health concern. No HMO with a convenient co-pay amount when their son or daughter develops an ear infection.

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

The cost of health insurance has changed drastically over the years as it has become more expensive. Depending on personal characteristic, the cost of health insurance may vary. For instance, as individuals grow older the more expensive it becomes. In this case, health insurance is more costly because “older individuals require more health care” therefore “the cost of providing health care is rising” (Madura &Atlantic, 2012). Not only does this affect the high cost of health insurance, but the number of individuals uninsured. As stated by Madura and Atlantic (2012), “about one in every five workers is uninsured” and has increased since then because health insurance has become unaffordable. As a result, individuals tend to seek health care elsewhere as they can no longer

Recently, a Consumer Driven Health Plan (CDHP), was created. There are many variables to a CDHP, such as benefits covered and coinsurance amounts, however there is one thing that all CDHP’s have in common – a high deductible. By having a high deductible, such as $1,200, it forces the plan participant to think about the medical services they are seeking. Do they really have to go to the emergency room for that cough or can they go to urgent care, or better yet, their physician the next day. When the plan

Rising health insurance premiums have made healthcare unaffordable in the United States. Health insurance premiums in this country have undergone a steady rise over the past few years while incomes have remained the same. More than 50% of individuals with low incomes holding private insurance in the United States are unable to afford their healthcare costs (Collins, Gunja, Doty & Buetel, 2015). In addition, costs related to healthcare are equally unaffordable to 25% of working-age individuals who hold private health insurance policies (Collins et al., 2015). According to the Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) survey on employer health benefits, employer-sponsored health insurance plans have also had moderate rises in premiums in 2013 for both individuals and family coverage (Claxton et al., 2013). While

Since the advent of health insurance in the 1950s, there have been many models of care that are come to the scene in an attempt to both control cost of care and improve quality of care. Insurance models came into being because the fee for service model used until then was proving to increase cost of healthcare without any measure of quality of services and care provided. Health insurance models have evolved from the basic hospital offered insurance to employer sponsored coverage plans. The US health system is broken both financially and quality wise with more than 20% of gross domestic product being spent on healthcare (Blackstone, 2016).

Health is improving for everyone to life a good and happy life. If you are healthy you are more likely to succeed comparing to an unhealthy person. Medical procedures are expensive and it's for people to spend so much on these checkups or surgeries. Health insurance gives an opportunity to pay less comparison to your actual bill amount for your medical procedures.

The impacts of a large portion of the population being uninsured can have an adverse reaction on the population who are insured. Study done by RAND Corporation and a UCLA shows that it hard for insured patients to find a regular source of care, have delay in their care or going care, and less satisfied with their care (Kelly, 2011, Para 2). Furthermore, high rates of uninsured population can also increase rate of acute health conditions and diagnoses. Thus, causing American health care to be more expensive and increase raise in disease, and sickness in the American population. According to Kaiser Family Foundation (2017), “Because people without health coverage are less likely than those with insurance to have regular outpatient care, they

Health insurance is essential in order to assist in paying for hospital and clinic visits. Without health insurance cost would be astronomical and people would not be able to afford health care. Blue Cross/ Blue Shield and Health Maintenance Organization, were some of the many insurance companies widely used before the Affordable Care Act. Although health insurances existed, many individuals and families were not able to afford them due to the increase in the cost of health care. New research over the years has enabled the creation of new medicine and technology in our practice. This leads to services being more expensive for individuals, which raises the price of insurance.

Many other glaring needs of health care reform were addressed through the ACA, but I want to focus on three main ripple effects that I believe need to be tackled in order to create a more well-balanced, consumer friendly health insurance market. 1) The amount of quality health insurance plans in America is dramatically decreasing: Health insurance used to be readily available in tiers; the highest tier, being the most comprehensive, had the highest monthly premium, but a low deductible (a patient’s out-of-pocket costs for surgeries, emergency visits, etc.). While the lower tier, which offered basic health care for routine visits, had a higher deductible. Today, insurance companies are being forced to offer “more affordable” plans,

Someone without health coverage are less likely to receive preventative care and therefore more likely to become ill which increases medical costs, [1].

You have made a lot of good points about the impact of deductible and co-payment on patients seeking health care. Did you know that 51.1% of low-income families reported have to delay or forgo treatment due to cost of care compared to 34.8% of higher income families? Based on this finding it was suggested to policymakers that deductibles be set based on income and family size. (Anonymous, 2010)

Prior to having a high deductible plan I had traditional personal choice insurance plan that I was able to get from my employer for my family of five for $240.00 a paycheck which was twenty six bi-weekly costing me $6,240 out of immediate salary with an eighty to twenty deductible. The first year my premium went down to $121.78 a biweekly paycheck. The high deductible was $2000. My employer paid $1000.00 and once deductible was met all costs under insurance were covered. Since then the premium went to $137.74 with a $3000.00 deductible. Currently my premium is $160.96 a bi weekly paycheck with a $4000.00 deductible and now an eighty/twenty deductible at office visits, prescription plans. There are allotted certain automatic fees for hospitalizations and high costs testing. A few preventative care costs are included for example, once a year well visits. If I pay into my HAS account I have started with fees as listed earlier then an ongoing fees of $5.00 a month to maintain it. In order to just cover the $4000.00 deductible I have to take out of my pay $153.85 bi weekly just to meet. In order to use advantage of tax free income the benefits of putting more into HAS do not outweigh other needs and costs. I have put in more than needed to meet deductible to help with copays. On top of what is not included my husband has type I diabetes on an insulin pump which the equipment is only covered 66%. Having using the insulin

The element of “choice” needs to be incorporated back into healthcare equation. American citizens have the right to choose, control and carry out their own plans for health care. Under the current system, individual liberties are slowly being stripped away while health care spending continues to spiral out of control. The following legislative plan eliminates waste and encourages enlightened, responsible choices made by businesses and individuals. Programs like Medicaid need to be streamlined and modernized to meet patient-centered goals (The Heritage Foundation, 2013). Another element of choice involves the promotion of alternative ways to seek portable healthcare including the utilization of health savings accounts and offering incentives such as pay-for-performance and rewarding progression from government assistance to employer-based care (The Heritage Foundation, 2013) The integration of Auto-enrollment technology into employer based-care statistically show to improve registration rates. (The Patient’s Choice Act of 2009, n.d.).

Moreover, the benefits of expanding coverage outweigh the costs for added services. [4] Safety-net care from hospitals and clinics improves access to care but does not fully substitute for health insurance. These findings are supported by much research, although some cautions are appropriate in using these results. People with health insurance are protected against uncertain and high medical expenses and are more likely to receive needed and appropriate health care. In addition, having health insurance is associated with improved health outcomes and lower mortality, so employees with health insurance are more likely to be productive workers. You do not pay income tax on health insurance benefits so it is more valuable per dollar than the same amount in taxable pay. [5]