Chronic Disease May Up Out-of-Pocket Costs for Insured
Researchers cite higher drug copayments for employees with diabetes, asthma, cancer and more
TUESDAY, Nov. 29, 2011 (HealthDay News) -- Among families with employer-sponsored health care plans, those coping with chronic illness pay more out of their pockets than those without chronic illness, primarily because of higher prescription drug copayments, a new study finds.
"Even when you are looking at the same level of total spending, families covering chronic conditions spent more out of pocket than those without chronic illnesses, and it doesn't appear to be because the families are in different types of plans," researcher Anne Beeson Royalty, a professor at Indiana University-Purdue University Indianapolis, said in a university news release.
"It looks as though the difference is because certain types of services -- such as prescription drugs -- are covered less generously," she added.
Royalty and colleagues analyzed data from a 10-year national survey of more than 47,000 American families and found that those dealing with chronic conditions spent 1.5 to two times more on prescription drugs.
For example, among households spending a total of $7,000 on health care, those with chronic conditions spent an average of $2,215 of the $7,000 on prescription drugs, compared with $1,065 for other households.
"Because average coinsurance for prescription drugs is much higher than coinsurance on other health care services, that means that the households with chronic conditions pay more of that $7,000 out of their own pockets than do other households -- roughly $500 more in this case. The differences grow more pronounced as total spending increases," Royalty explained in the news release.
She and her colleagues said the study raises questions about how health care plans are designed. They suggested that employers and insurers should investigate whether better-designed health plans would promote the use of "high value" services (for example, taking prescription medicines) by cutting the patients' out-of-pocket costs of these services.
"If a person can keep a chronic condition under control with medication, not only will that produce better health but also fewer expensive hospitalizations," Royalty said.
Total spending was defined as what the insured family paid in out-of-pocket copayments and/or deductibles plus what the family's insurance company paid health care providers. The chronic conditions were asthma, cancer, diabetes, anxiety and depression.
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