How Delayed Care Drives an Uncontrollable Spiral of Chronic Disease
At this point, we are setting inflation records on a monthly basis.
According to data published by the US Bureau of Labor Statistics in early June, the consumer price index rose 8.6% in May from a year earlier. This is the largest 12-month increase in the CPI since December 1981.
With inflation on the rise, people have less wiggle room in their budget. These dynamics impact spending in all areas of our lives, and health care is no exception. According to the Bureau of Labor Statistics, health insurance costs increased by 13.8% from May 2021 to May 2022.
Based on inflation trends, an employee earning $50,000 a year actually has $2,500 less to spend on health care than just 12 months ago. These constraints only make it harder for people to afford the care they need – and the result will be an increase in delayed or abandoned care. Delayed care has negative consequences for both employees and employers.
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This is especially true for people struggling with chronic health conditions. During my practice, I treated countless patients who had problems such as high blood pressure, diabetes or depression.
Managed well, these conditions follow a simple disease model: their symptoms are easy to live with and they pay a relatively small fee. But when their conditions aren’t managed appropriately, these same patients can face incredibly disruptive symptoms and rapidly escalating expenses.
Think of diabetes, which impacts a estimated 37.3 million American adults. A person with high blood sugar can usually take medication by mouth, make some basic changes to their diet, and lead an otherwise normal life. But in other cases, the diabetes gets worse.
When a primary care doctor notices this change, they usually refer the patient to an endocrinologist, a doctor who specializes in diabetes care. The specialist will order a variety of lab tests, and they might start the patient on a low dose of insulin. If the GP and the specialist act together to help the patient, things return to normal.
But if the patient can’t see a specialist or take these crucial steps, their high blood sugar can quickly spiral out of control. Uncontrolled diabetes can eventually lead to nerve problems, heart disease, and even blindness or amputation. These secondary problems quite quickly decrease the patient’s quality of life and increase their medical costs.
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High blood pressure is another common medical condition, affecting approximately 47% of adults in the United States. For most people, this is a problem that has no symptoms. Often, doctors only discover the problem during routine examinations. It’s easy to treat, and most people do well with one or two inexpensive medications that have minimal side effects.
Most people with hypertension have “primary hypertension” (ie hypertension without an identifiable cause). But a small number of patients have “secondary hypertension”. In these patients, they might be dealing with an abnormality like a tumor or problems in the arteries of the kidneys. Doctors may suspect secondary hypertension when medications that usually work to treat high blood pressure don’t help; routine lab work can also detect these problems.
When doctors suspect secondary hypertension, they may order lab tests and imaging exams (eg, CT scans) to sort out the issues. These tests incur costs, and patients are often responsible for covering at least some of these bills.
People who fear paying out of pocket for care before they reach their deductible could delay or avoid these tests. This means that their blood pressure remains elevated until the root cause is addressed. And having high blood pressure for a long time can lead to heart attacks, strokes, and kidney disease.
Finally, I would like to address depression. Anxiety and depression are extremely common, and rates have increased by 25% since the start of the pandemic. Being depressed can have serious effects on people, leading to a drop in satisfaction with all areas of life, including work.
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Unfortunately, depression can make other health problems worse by robbing people of their motivation to take care of themselves. Managing high blood pressure, diabetes, or any other medical condition takes energy — and depression steals that energy from the people it affects. People who have been diagnosed with major depression usually have twice as much health spending like other commercially insured Americans.
Most depressions are easy to treat. The therapy is quite effective for those who have access to it, and many cases can be treated with just one drug. But there are times when doctors need to add more drugs or even involve a psychiatrist. Psychiatrists frequently order tests to help narrow down potential problems — and help the doctor figure out how to best help the patient — but those tests can cost up to $2,000.
A few patients may even require sophisticated treatment like transcranial magnetic stimulation, or TMS, to help resolve their symptoms. These treatments also come with significant costs, and any delay in these treatments means the depression doesn’t get better — and could even get worse.
In each of these examples, costs can be a barrier to getting the care people need. Co-payments for seeing primary care doctors tend to be low (sometimes even free), although visits to a specialist usually cost more. Lab tests, medications, and supplies incur additional expenses. In light of this, some patients choose to delay care. In fact, 34% of the members we cover through Paytient tell us they would skip or delay care if they didn’t have access to interest-free credit to give them more time to pay.
With all of these chronic conditions, preventative care is cheaper and more effective than reactive care. At every stage, skipped care results in higher costs and poorer outcomes, which hurts the employee while hurting business results.
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What can employers do to help solve the affordability problem? Wellness programs that encourage early primary care are a good start – perhaps those who see their doctor in a timely manner can get a discount on their health plan contribution.
Virtual solutions are another good perk to offer. Solutions such as Galileo (which provides virtual primary care) and Hinge Health (which offers in-home physical therapy) can be cheaper than traditional alternatives, and they allow greater access. Finally, products like Paytient (where I work) help people pay for care by giving them access to interest-free credit that they can use to cover their healthcare expenses, regardless of their health status or design. of their health insurance plan.
Solutions that allow employees to manage affordability and access issues will pay dividends, both in terms of employee quality of life and the financial health of the employer’s health plan. Only one question remains: how do you help your team?