One of the most important things my staff and I do at the end of each day is call our patients. Sometimes it’s a reminder for their follow up visit. At times, it’s a request to schedule a visit to address their diabetes or heart failure. At other times, it’s a call to women who are overdue for cervical cancer screening and need come in for their PAP smear. We do this to make sure that our patients get the care they need and stay healthy.
What my staff and I do is no different than what any other physician’s office, medical center or hospital does. In taking care of our patients, when we know something is supposed to be done, it’s our duty to make our best effort to get it done. In doing so, we are reducing barriers to care, by taking some of the responsibility for following up off of our patients’ shoulders and putting it in our own.
As a public health issue, there is a growing understanding that lowering barriers to care will help improve outcomes, by increasing access to the care that people need. Another such barrier to care is insurance co-pays for office visits.
An interesting study (that’s a few years old) looked at the effect of various levels of co-pays on health care utilization and outcomes. People enrolling in insurance were randomly assigned to a plan that either had no co-pay, 25% co-pay, 50% co-pay, 95% co-pay or a deductible. They found that, in general, increasing the level of co-payment decreased health care utilization without adversely affecting health outcomes. However, when they broke down the data, they found that those who were the sickest had worse health outcomes the higher their co-pays.
An oft heard solution to helping bring health care costs down is increasing co-pays or deductibles to make sure that patients have “skin in the game”. This is a reasonable solution, as long as you are relatively healthy. The great majority of people are in decent health, and so increasing costs causes them to decrease non-necessary services. For those who have chronic illnesses, frequent visits and care are necessary and decreasing utilization means foregoing necessary, not optional, care. This loss of necessary care leads to worse health outcomes.
Part of reducing barriers to care is recognizing what the real barriers are. But knowing that high co-pays for the sick worsens health outcomes is not enough. The next step is to actually reduce that barrier, to decrease or eliminate co-pays for the sickest. Are we wise enough to take that next step?