The Price We Pay For Cost-Sharing

by Patrick Appel

Cost Sharing

Aaron Carroll notes that high copays keep people with chronic illnesses from getting medical care:

study just published in JAMA Pediatrics looked at how children with asthma obtained care under different levels of cost-sharing, and how much stress their families were under financially because of their child’s illness. It’s important to understand that children with asthma, by definition, require care. We want them to use the health care system. With respect to asthma, prevention and maintenance are far better than trying to treat a child already suffering from an attack.

What we see from this study is that families with higher levels of cost-sharing were significantly more likely to delay or avoid going to the office or emergency room for their child’s asthma. They were more likely to have to borrow or cut back on necessities to afford care. They were more likely to avoid care. This isn’t a good outcome. We’re talking about children with a completely manageable chronic condition who are being hampered by cost-sharing. That’s not what cost-sharing is supposed to do.

He points out that it “doesn’t have to be this way”:

In France, co-pays are set by levels of sickness. Those who have chronic conditions have all of their co-pays waived. Even Singapore, beloved among conservative health care wonks because of its reliance on cost-sharing, makes exceptions for many with chronic illnesses. The rules do so explicitly to encourage them to seek care.