Hutchinson Internment Camp Money

The Rise of Forced Choices Between Money and Health

Who knew that financial toxicity was a thing? Perhaps like us, you have merely thought of it as the financial burden of healthcare – without assigning it the status of a medical complication that dysfunctional healthcare causes. But recent publications are making it ever more clear that people living with chronic diseases are having to make forced choices between money and health.

What caught our attention this week were two studies related to this problem in diabetes care. They tell us the problem is rising. They also tell us private insurers are making it worse and unnecessarily harming the health of their customers.

High Out-of-Pocket Costs

Researchers at the University of Michigan documented out of pocket costs for people living with diabetes between 2009 and 2018. They found substantial out-of-pocket costs that were especially high and rising for persons with type 1 diabetes. Medication costs account for more than half of these costs for people with either type 1 or type 2 diabetes.

Authors Evan Reynolds and colleagues concluded that screening for financial toxicity is becoming important in the delivery of diabetes care:

“Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs).”

The Value of Preventive Drug Benefits

The second study helps to make it clear that this problem is utterly unnecessary. J. Franklin Wharam and colleagues studied the effects of value-based drug benefits. In particular, they looked at the health outcomes for diabetes patients who switched into a a drug plan that used preventive drug lists (PDLs). These PDLs emphasize lowering the out-of-pocket costs for high-value preventive drugs like diabetes medications.

In this interrupted time series study design, persons whose employers did not offer such a benefit served as a control group.

The result impresses us. Preventable diabetes complication days dropped by eight percent with the adoption of PDLs. The benefit was even greater – ten percent improvement – in subjects from low-income communities.

Forced Choices in a Dysfunctional System

So why does health insurance persist in presenting its customers with forced choices between money and health? The easy answer is to blame the profit motive of health insurers. But the real reasons are more systemic. Drug prices in the U.S. are out of control and the impulse to pass some of this problem to consumers is quite natural.

Living with such broken systems for healthcare have led us to accept unconscionable disparities in healthcare. One result is that advanced obesity care reaches only a tiny fraction of the people this disease affects – most often only the wealthy and the well-insured.

It’s profitable for some. Financially toxic for many more of us.

Click here for the Reynolds study and here for the Wharam study. For further perspective, click here and here.

Hutchinson Internment Camp Money, photograph by Raimond Spekking, licensed under CC BY-SA 4.0

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February 18, 2024