Life disruptions for midlife and older adults with high out-of-pocket health expenditures

Abstract

PURPOSE Out-of-pocket cost sharing for health care expenses is a growing burden. Prior research has emphasized the medical consequences of cost sharing. This study investigates the range of social, medical, f nancial, and sometimes legal disruptions from high out-of-pocket health expenses. METHODS We conducted open-ended, semistructured interviews with 33 insured patients (two-thirds covered by Medicare). All had chronic illnesses and sought philanthropic f nancial assistance. RESULTS We found that high levels of cost sharing precipitated considerable anxiety and substantial debt problems, as well as disruptions of medical care. Participants described various borrowing strategies (eg, credit cards), legal problems (eg, debt collections), and threats to their nonmedical household budgets (eg, food, housing). Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benef ts with exceptional detail but described considerable anxiety about changes to those benef ts that could easily disrupt carefully managed household budgets. Benef t designs that resulted in large a variations in f nancial liability from month to month (eg, large deductibles or coverage gaps) imposed considerable f nancial challenges. CONCLUSIONS As health care cost sharing grows, policy makers will need to consider the consequences of high cost sharing for families facing strained household budgets. Although the generosity of health insurance is important, continuity of benef ts and month-to-month stability of f nancial liability are also important and may be undervalued in policy discussions.