While millions of Americans are re-enrolling in Obamacare, signing up for health insurance for the first time, or double-checking the plans their employer offers, many will undoubtedly ask what’s affordable for them.
Good luck defining affordability. Like beauty, it’s in the eye of the beholder.
To better understand what affordability in health care means from the vantage point of the ‘kitchen table,’ the National Quality Forum, with support from the Robert Wood Johnson Foundation, got an extraordinary group together to talk about the cost of care.
We sat down with consumer advocates, insurers, doctors, nurses, and others to discuss how rising costs affect U.S. families. We couldn’t have done it without actual patients who provided a constant reality check.
They told us that business owners see the cost of care a lot differently than employees, and retirees have a different point-of-view than a self-employed person or a middle-class mom managing the family budget. Everyone defines affordability differently. The one constant, however, is that health care costs are taking a bigger slice of the pie. Even if they get health insurance through their jobs, we heard over and over that people are struggling under the weight of higher co-pays, rising deductibles and larger premiums.
Are we finally at the point when “costs more” has become “costs too much?” Maybe.
The consumers we talked with first judged whether care was affordable based on what their out-of-pocket costs were, relative to their family’s overall budget. They take into account that tradeoffs may need to be made. Quality is important, too, as Americans want high-quality care at the best possible price.
Affordability means one thing when a patient is selecting a preventive test or screening. But it means something entirely different when dealing with an unexpected illness that suddenly requires immediate attention, or when dealing with a chronic condition like diabetes or heart disease.
As people shop for insurance this fall, we’ve developed materials to help people better understand today’s health care environment. Here are five questions to ask:
1. How should I choose insurance? How do I choose the best insurance plan for me — what are the premiums, copays, deductible, prescription costs, maximum out-of-pocket, and network of general doctors and specialists — and how much am I willing to pay?
2. How do I pick a doctor? Does my new insurance pay the doctor bills? Is the doctor’s office open after normal business hours or on weekends? Are they part of a larger practice that offers me access to specialists or diagnostic tests if I need that? Can I make monthly payments if I get a really big bill?
3. How does this health care help me get well? Do my new doctors and the local hospital offer high-quality care, and how do I know? What are my treatment options? Can I shop around for labs tests or scans to get the best bang for my buck?
4. How do I stay healthy? Will my new care be personalized so I get advice on how to prevent diseases? How do I deal with screenings, vaccines, or other care? What would I pay if I need these things?
5. Suppose I am sick, how do I manage a disease or condition? Are there people at the primary care doctor’s office to help coordinate my care with specialists? Do specialists talk to my primary care physician, or to each other? Or do I have to be their intermediary?
We’re a long way from declaring U.S. health care affordable, but we are increasingly able to help the different stakeholders in and around health care define it for themselves. For too long, conversations about health care costs have focused on doctors, hospitals, the government, or insurers — but rarely on consumers and families, who of course ultimately pay the bill. At long last, we are asking the right questions, with the right people in the room.
Christine K. Cassel is president and CEO, National Quality Forum.