The U.S. has a vast network of healthcare services, but access to adequate care remains a challenge, not because of a lack of facilities, but because of the high costs involved. Nearly half of all U.S. adults struggle to afford health care, and around 41% are in medical debt.
Healthcare decisions are too often dictated by the cost of care rather than the care itself. This concerning trend can negatively impact patient health and well-being.
As a physician, what can you do to help?
Support and guide your patients. Offer them valuable advice and resources to help manage their healthcare costs.
In this article, we'll explore the impact of rising healthcare costs and discuss practical strategies that healthcare providers can use to support their patients in planning and managing financial challenges.
The U.S. healthcare spending increased by 7.5% in 2023, outpacing the GDP growth rate of 6.1%. Furthermore, the average National Health Expenditure (NHE) is projected to rise at an annual rate of 5.6% from 2023 to 2032, exceeding the anticipated GDP growth of 4.3%.
How will this widening gap impact both patients and providers? Let’s explore.
Rising healthcare costs are not just a challenge for low-income, uninsured adults; they also significantly impact insured individuals. Nearly half (48%) of insured adults express concern about affording their monthly health insurance premiums. As healthcare costs continue to rise, they create hurdles that impact patients in the following ways:
When patients forgo care due to financial barriers, healthcare providers face numerous challenges that can jeopardize their operations and the quality of care they deliver.
High-deductible insurance plans, confusing payment structures, and limited financial literacy make it challenging for patients to plan and budget their healthcare expenses. Physicians are vital in bridging these knowledge gaps and helping patients understand their insurance coverage, costs, and options for managing medical expenses. Here are a few strategies to help ease patients' healthcare costs.
One of the simplest ways to lower healthcare costs is to switch to generic drugs or more affordable alternatives that contain the same active ingredients and offer the same therapeutic benefits as brand-name medications but at a fraction of the cost. Additionally, for patients with chronic conditions, consider recommending bulk orders of prescription drugs through online pharmacies or mail-order services, which often offer lower co-pays and discounts for purchasing in larger quantities.
Choosing the right health plan is critical in beating rising healthcare costs. Emphasize the importance of enrolling in a plan that meets their healthcare needs and fits their budget.
Many people opt for low-premium, high-deductible plans to reduce monthly expenses. Clarify the trade-offs between lower premiums with higher deductibles and higher premiums with lower deductibles to help them make an informed choice. Encourage patients to explore options like the Premium Tax Credit (PTC), which can help reduce health insurance premiums when enrolling through the Health Insurance Marketplace.
Furthermore, many patients don't understand the influence of out-of-pocket limits, deductibles, copays, and co-insurance shares. Assist when needed, and if they qualify for cost-sharing reductions, advise them to enroll in a silver plan that could offer additional savings. This benefit can significantly lower their deductible, copayments, coinsurance, and out-of-pocket limit, making healthcare more affordable.
Encourage patients to review their health coverage and benefits regularly to avoid missing out on covered services or potential savings. Help patients understand and fully utilize their insurance benefits, including coverage for routine check-ups, transportation, mental health care, screenings, and preventive care services.
Explain the potential savings associated with staying in-network and the higher costs of out-of-network services. Encourage patients to verify that all their healthcare providers, from primary care physicians to specialists, are in-network to avoid unexpected charges.
Additionally, when referring patients to specialists or coordinating care, always check for in-network options to help them minimize expenses. Ensure that the laboratories, imaging centers, and hospitals they use are part of their network, as even routine tests or procedures can become costly if performed out-of-network.
Educate patients on outpatient or ambulatory care options for procedures and treatments. Highlight that outpatient facilities often have lower overhead expenses than hospitals.
Encourage patients to enquire if a recommended procedure can be safely performed in an outpatient setting. For example, many surgical procedures that once required a hospital stay, such as cataract removal, certain orthopedic surgeries, and gastrointestinal procedures, can now be done safely and efficiently as an outpatient procedure, avoiding the added costs of an inpatient admission.
Many patients are unaware that different care settings, such as emergency rooms (ERs) and urgent care centers, come with significantly different costs. Emergency care is generally more expensive than urgent care and primary care.
Recommend that patients go to urgent care for non-life-threatening issues and use the ER for critical emergencies. For example, they could use an ER for chest pain, severe injuries, difficulty breathing, or symptoms of a stroke, and urgent care centers for minor cuts needing stitches, sprains, mild asthma attacks, or flu symptoms.
The timeless adage "prevention is better than cure" isn't just a cliché; it's a practical strategy to cut down on medical expenses.
Most insurance plans cover preventive care with little to no out-of-pocket cost for the patient. Encourage patients to take advantage of these benefits while emphasizing the importance of regular screenings, vaccinations, and wellness visits to help detect health issues early. Early detection and treatment improve patient outcomes and reduce long-term healthcare costs.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are alternatives for patients to save pre-tax dollars for qualified medical expenses. These accounts can help cover medical expenses like deductibles, co-pays, prescription medications, dental care, vision care, and certain over-the-counter items. While HSAs are available for individuals enrolled in high-deductible health plans (HDHPs), FSAs are typically offered through employer-sponsored health plans.
Include the insurance company's customer service numbers and links to state and federal assistance programs on patient portals and alongside patient bills. These resources can help patients understand their insurance benefits, resolve billing issues, and explore financial aid options. Additionally, provide contact information for local non-profits, community health organizations, or patient advocacy groups that offer financial counseling, medication assistance, or other resources to reduce costs.
Helping financially strained patients manage their healthcare costs without compromising their health elevates their physical and financial well-being. Moreover, it strengthens your relationship with your patients, builds trust, enhances communication, and improves patient retention, ultimately helping your practice thrive.
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