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The KFF survey on delaying or not getting care due to cost is very interesting, Millions of Americans (me included) have spent a good part of their lives in a low-deductible or zero-deductible plan. Their instinctive response to a treatment with a real price tag is to hold back and look for another option.
Obviously if they don’t have the money for the treatment they will hold back. But even if they could pay for it, they will delay and probably complain.
I am no different. A few months ago I went to a specialist who is not in my normal Med Advantage network. He told me about a treatment that is not covered by Medicare, and the cost would be over $1000. My first response is that he must be a quack. If he was legitimate, Medicare would cover his care.
“My first response is that he must be a quack. If he was legitimate, Medicare would cover his care.”
Did you have second thoughts?
Seems to me you placed a very large (and in my opinion unwarranted) amount of trust in Medicares coverage decisions as indicative of medical necessity. After all, Medicare is an enormous insurance organization whose coverage decisions are influenced by all the same financial incentives of any other insurer,
Questions about the effect of deductibles and other forms of cost sharing on patients are not new. RAND Corp. conducted one such study, a large-scale, randomized experiment between 1971 and 1982. Although it was completed in 1982, even 20 years later it remained the only long-term, experimental study of cost sharing and its effect on service use, quality of care, and health.
One of RANDs findings is famous (or infamous, depending on one’s personal views):
“In general, the reduction in services induced by cost sharing had no adverse effect on participants’ health. However, there were exceptions. The poorest and sickest 6 percent of the sample at the start of the experiment had better outcomes under the free plan for 4 of the 30 conditions measured.”
Google “rand corp study cost sharing in health plans”
This takes you to the RAND report on its 1971-1982 study and other related work from RAND.