These top-of-the-line practitioners validated the report findings that affordability plays a role in healthcare utilization. When Medicaid expanded in Ohio, Cleveland Clinic saw a 60 percent increase in the number of Medicaid patients and an 86 percent increase in outpatient visit but only a 20 percent increase in inpatient visits.
They also highlighted potential links between the growth of high deductible plans and consumers’ healthcare utilization patterns. As an insurer, Humana sees evidence of care being delayed but also care being skipped entirely. In addition to the cash flow problems identified in our study, out-of-pocket costs appear to drive consumers to skip even “high value” care, such as preventive care and medication adherence. Unfortunately, it appears that giving consumers more "skin in the game" causes them to defer “high value” care.
As the degree of coinsurance in standard plans has expanded, the Cleveland Clinic has seen a shift in demand for outpatient and diagnostic services toward the last quarter of the year, when patients are more likely to have reached their deductibles (but no shift in the timing of demand for inpatient care).
But these outpatient services almost always reduce complications and bring down the total cost of care. High levels of coinsurance encouraged consumers to avoid using all healthcare services, not just the high-cost care. This is not an effective way to contain healthcare costs.
Yet, reducing total cost is crucial for ensuring that consumers get the care they need, when they need it. Across government, employers, providers, charities, and patients—someone has to cover these costs. Shifting the burden back and forth among these players will not address the fundamental problem of affordability. Bringing together the perspectives of employers, healthcare providers, insurers, and innovators, the panel reinforced a few key takeaways for how the healthcare system can reduce total healthcare costs in order to help consumers receive the care they need when they need it and not just when they have the cash to pay for it. We highlight three key takeaways that deserve continued attention and focus at a time when healthcare costs are on the rise and too many families do not have enough cash to weather extraordinary medical payments.