News Archive

High Copayments and Coinsurance Cause Employees to Delay Needed Health Care
Source: Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015, Commonweath Fund Report

Copayments and coinsurance create disincentives for many people--especially those with low incomes--to get needed health care services.

How Do Deductibles and Copayments Affect People's Health Care Decisions?

Employers and insurers have made the argument that deductibles and copayments in health plans create disincentives for consumers to overuse health care or use services that might be of limited value. The survey finds evidence that cost-sharing also creates disincentives for people to get necessary care, like going to the doctor when they are sick or filling prescriptions for their medications.We asked adults whether their deductibles had affected their decisions to get needed health care over the past year. Adults whose deductibles were high relative to their income were significantly more likely to report delaying or avoiding needed health care than those with lower deductibles.

Effects of Copayments and Coinsurance on Health Care Decisions

Copayments and coinsurance also created disincentives for many people--especially those with low incomes--to get needed health care services. 40% of adults with deductibles that amounted to 5 percent or more of income reported that because of their deductible: they hado not gone to the doctor when sick,o did not get a preventive care test,o skipped a recommended follow-up test, oro did not get needed specialist care.

Adults with lower deductibles relative to their income were less likely to avoid needed care, but 21% said they did not get needed care because of their deductible.

39% of adults with incomes under 200 percent of poverty ($23,340 for an individual or $47,700 for a family of four) said that because of their copayments or coinsurance, they had either...o not filled a prescription,o not gone to the doctor when they were sick,o skipped a medical test or follow-up visit recommended by a doctor, oro not seen a specialist when they or their doctor thought they needed one.

19% adults with relatively higher incomes also reported that their copayments were barriers to filling prescriptions or getting needed medical care.

This issue brief draws from the second installment of the Commonwealth Fund Health Care Affordability Tracking Survey to measure the extent to which U.S. adults have high health care cost burdens. We created what we call the Commonwealth Fund Health Care Affordability Index, a composite measure that assesses the share of U.S. adults who have high premium costs, high deductibles, and/or high out-of-pocket health care costs relative to their incomes (see graphic below). In addition, we asked adults about how they perceive the affordability of their premiums, deductibles, and copayments or coinsurance. Adults also told us how their deductibles and copayments affected their health care decisions in the past year.

The data reflect the health insurance and health care expenditures reported by adults who were insured continuously all year with private insurance through an employer, the Affordable Care Act's marketplaces, or the individual market.

The majority of the survey sample has employer coverage (90%), but the sample also includes people in marketplace plans (6%) and with individual coverage (5%). In the survey, 61 percent of U.S. adults had been insured continuously with private coverage for the prior 12 months, up from 56 percent one year earlier (data not shown).

About The Commonwealth Fund

The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. Visit www.commonwealthfund.org

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