Ideology Meets Reality: What Works and What Doesn't in Patient Exposure to Health Care Costs

15 Indiana Health Law Review 43 (2018)

Arizona Legal Studies Discussion Paper No. 18-03

24 Pages Posted: 2 Feb 2018

See all articles by Victor Laurion

Victor Laurion

University of Arizona - College of Medicine

Christopher T. Robertson

University of Arizona - James E. Rogers College of Law; Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics

Date Written: January 31, 2018

Abstract

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

Laurion, Victor and Robertson, Christopher T., Ideology Meets Reality: What Works and What Doesn't in Patient Exposure to Health Care Costs (January 31, 2018). 15 Indiana Health Law Review 43 (2018); Arizona Legal Studies Discussion Paper No. 18-03. Available at SSRN: https://ssrn.com/abstract=3116234

Victor Laurion

University of Arizona - College of Medicine ( email )

Department of History
Tucson, AZ 85721
United States

Christopher T. Robertson (Contact Author)

University of Arizona - James E. Rogers College of Law ( email )

P.O. Box 210176
Tucson, AZ 85721-0176
United States

HOME PAGE: http://www.law.arizona.edu/faculty/getprofile.cfm?facultyid=714

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

23 Everett Street
Cambridge, MA 02155
United States

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