JustCare

Tag: Social determinants

  • Medical debt more prevalent among Medicare Advantage enrollees than traditional Medicare enrollees

    Medical debt more prevalent among Medicare Advantage enrollees than traditional Medicare enrollees

    Steffie Woolhandler, David Himmelstein et al. write in JAMA Network about medical debt, which more than 18 percent of American households shoulder. What’s particularly noteworthy is that people in Medicare Advantage are more likely to have medical debt than people in traditional Medicare with supplemental coverage and people with traditional Medicare only.

    We already know from a multitude of studies that millions of Americans hold significant medical debt. And, the most vulnerable Americans are most likely to have medical debt: People without insurance, people with disabilities and people requiring hospitalization. But, health care costs are so high and insurance coverage so rarely comprehensive that medical debt touches a broad swath of Americans.

    People in Medicare Advantage plans are, like the most vulnerable, most likely to find themselves burdened by medical debt. In 2016, one in four people with Medicare spent 23 percent or more of their income on medical care.

    Medical debt across the US averages about $2,306 per individual and $4,671 per household. The authors find that medical debt is likely to cause an increased risk of poorer social determinants of health. People with medical debt are often unable to cover their electricity, phone and gas bills, and have an increased risk of housing and food insecurity. Housing and food insecurity also cause poor health. “Unaffordable medical bills … contribute to a downward spiral of ill-health and financial precarity.”

    Here’s more from Just Care:

  • Should health insurers help patients with travel costs?

    Should health insurers help patients with travel costs?

    Access to health care is a surprisingly small determinant of people’s health. Education, housing, food and transportation contribute significantly more to people’s well-being. So, health insurers, hospitals and others are experimenting to help patients with travel costs as well as the costs of other “social determinants” of health. Phil Galewitz reports for NPR on one experiment in Philadelphia that is not working as imagined.

    To help ensure that low-income patients in Philadelphia came for their doctor’s appointments, patients were offered free transportation. More than one in three were not showing up. But, the free transportation did not help to get them to their doctor’s office.

    A doctor leading the study was “super surprised.” The patients said that they either were saving the free ride for an “important” appointment or that they preferred to travel the way they always did.

    This is not the first study of its kind looking at how improving social determinants of health can improve health and reduce health care costs. In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients’ social needs improves health and lowers medical costs.

    It’s still unclear what types of interventions help. It appears that different interventions help different people. Billions of dollars of investments continue to flow towards finding successful interventions.

    North Carolina is investing $650 million in housing, food and transportation for people with Medicaid over five years to determine whether these investments promote better health outcomes. California is also focused on enhancing social services for its Medicaid population. Experts agree that simply improving access to care will not improve health outcomes for people with low incomes.

    Since enactment of the Affordable Care Act, focus has been on paying physicians a lump sum to care for patients and linking that sum to the value of the care they provide. It sounds a bit like magical thinking, frankly. Just as health care does not on its own determine patient health outcomes, doctors can only do so much. It seems like an exercise in futility to assess a doctor’s contribution relative to other factors. But, we shall see.

    The investment in helping patients with housing costs is sizable. In one case, the cost of housing 25 people for a year is $700,000, $28,000 a person. Will it save money? It could if it keeps people out of the hospital. A one-week hospital stay can easily cost way more than that. But, the money to test the proposition over a prolonged period will not be easy to find. It would be far better for the federal government to guarantee everyone in need decent housing.

    Here’s more from Just Care: