Ideology Meets Reality: What Works and What Doesn't in Patient Exposure to Health Care Costs
15 Indiana Health Law Review 43 (2018)
24 Pages Posted: 2 Feb 2018
Date Written: January 31, 2018
U.S. policymakers, scholars, and advocates have long displayed an ideological commitment to exposing insured patients to substantial out-of-pocket expenses. These commitments derive from both overt political ideologies, which favor individual responsibility and oppose redistribution of wealth and risks, as well as more-subtle ideological commitments of academic economists, which link observed patterns of consumption to value-claims about welfare. In this symposium contribution, we document those ideological commitments and juxtapose them with a review of the scientific evidence about the actual effects of patient cost-sharing. We find, as economic theory predicts, that patients exposed to healthcare costs consume less healthcare. However, a fair review of the evidence — including the effects on health outcomes, access to care, and financial insecurity — makes it very hard to conclude that substantial and untailored cost-sharing exposure — as we have seen in actual application — is good social policy. We suggest directions for future study and reform.
Keywords: health insurance, out-of-pocket expenses, cost-sharing, underinsurance, health outcomes, access to care, financial insecurity, ACA, deductibles, copays
Suggested Citation: Suggested Citation