Out-of-pocket healthcare costs tarnish patient experience

Insurance design creates coverage uncertainty

Healthcare consumers struggle with understanding their benefits design, creating hurdles for healthcare access and issues when certain services get denied.

Overall, 41% of insured patients taking a prescription drug said either they or a family member has faced a care access barrier because their insurance delayed or denied the service. This trend was more common among patients with a chronic illness, 51% of whom reported an insurance delay or denial.

Patients continue to worry about their healthcare coverage moving forward, with 43% saying they're worried their insurance will deny care again in the future. Half of patients said they can't anticipate what they'll pay for their prescriptions and 45% said they struggle to understand their health insurance coverage, indicating poor explanation of benefits and plan navigability.

Healthcare consumers don't have a great outlook for their insurers, either. Only about a quarter of respondents said they think insurance providers give all beneficiaries affordable access to the care they need. Just under two-thirds of insured patients (64%) think that insurance companies and pharmacy benefit managers need to be held accountable for certain practices like prior authorization and step therapy.

Out-of-pocket costs worry patients

It's not just coverage for services that worry patients; it's the out-of-pocket healthcare costs they'll incur for those services, too. In fact, patients are just as worried about affording their medical bills as they are worried about affording their groceries.

These concerns are driven by increases in out-of-pocket patient costs, with a third of respondents saying their healthcare expenses increased over the past year. Among folks who take prescription medications, 38% reported increases in out-of-pocket costs.

These high costs are impacting patient engagement and medication adherence. A quarter of respondents who are prescribed medication said they didn't take their medication in the past year because they couldn't afford it.

Moving forward, about a third of respondents supported reducing the burden of deductibles and placing stricter limits on out-of-pocket costs, the survey showed. Another 89% said having consistent out-of-pocket costs for a single medication would be helpful.

Patients prioritize personalized medicine, preventive care

In addition to healthcare affordability issues, the survey looked at healthcare consumer preferences for medical innovations. A majority of respondents (91%) said they're hopeful about the innovative medicines that have recently been developed to treat deadly and costly conditions.

Still, patients acknowledge the need for safe and effective preventive care. Most patients (89%) said they prioritize knowing that their treatments are safe and effective. Another 90% said that preventive services are essential for keeping them out of the hospital and doctor's office.

Consumers also expressed interest in personalized medicine, with 91% saying there needs to be more choices in medicines to meet their needs and 95% saying it's important for treatments to be personalized to individual cases.

As healthcare consumers consider the policy landscape shaping their healthcare experiences, they want to see leadership address out-of-pocket costs, the survey showed. A third of patients said reining in patient spending is a top issue for them, while 94% said policymakers need to better understand the barriers that keep them from engaging in care.

Sara Heath has covered news related to patient engagement and health equity since 2015.