Photo Credit: Fahmi Ruddin Hidayat

Healthcare professionals and patients share perspectives on US healthcare hurdles, highlighting the need to improve affordability and care.

Recently, there have been numerous conversations about healthcare in the US, focusing on identifying and addressing issues such as high costs, insurance coverage, out-of-pocket costs for patients, and limited or lack of access to essential healthcare for diagnostic tests and therapies.

For decades, healthcare professionals and patients have voiced various challenges about healthcare and insurance, with the most cited challenges for health care including administrative burdens, staff shortages, meeting patient quotas, and time spent dealing with insurance claims, prior authorizations, and denials.¹ According to a recent survey on the Kaiser Family Foundation website, many Americans face challenges with the costs of healthcare, and the findings revealed the following:²

Healthcare Affordability

• About 50% of US adults report that the affordability of healthcare costs is often a challenge.
• An estimated 25% of those surveyed stated that they faced issues paying for healthcare in the past year, especially for younger adults, those with lower incomes, those in fair or poor health, and the uninsured.²

Delaying Care

• Due to healthcare costs, 25% postponed or skipped needed healthcare, and 61% of uninsured adults went without healthcare because of out-of-pocket costs.²

Prescription Drug Costs

• Due to the cost of medication, 21% did not fill prescriptions, and a comparable percentage opted to take over-the-counter alternatives. An estimated 10% cut pills in half or skipped doses.²

Insurance Challenges

• About 48% of insured adults expressed concerns over monthly premiums and out-of-pocket costs.²

Healthcare Debt

• About 41% of adults surveyed reported some medical or dental bill-related debt.²

Ongoing Concerns

• About 74% are “very” or “somewhat” worried about unexpected medical bills.
• About 73% are concerned about healthcare service costs for themselves and their families.
• About 50% reported being unable to pay an unexpected $500 medical bill in full without going into debt.²

The complete survey results can be found here.

Healthcare Professional Perspectives

A pharmacist stated, “In the retail setting, I encounter many patients unaware of the various manufacturer-sponsored cost savings prescription programs that can make some medications affordable for eligible patients. Many patients decline the prescription after seeing the out-of-pocket costs for certain medications. Given the limited eligibility for some cost-saving programs, I remind patients to explore potential savings with GoodRx if practical. Many patients express frustration with the high costs of medications. Fortunately, the availability of generic medications and biosimilars in many therapeutic categories provides patients with lower-cost alternatives and expands access to the needed medications depending upon the medical condition.”

An internist stated, “In my practice, I have encountered many patients who do not adhere to medication or simply discontinue the medication because of the out-of-pocket costs, which in turn adversely affects clinical outcomes. Depending on the disease, medications can be changed to more affordable options, including generic drugs. It is essential to keep the lines of communication between professionals and patients open because some patients will not discuss the financial burdens of accessing medications. Many of my older patients who are likely to take multiple medications face challenges in affording all their medications, so I always encourage them to discuss this issue with me so we can find affordable options if needed and if possible. It would be great if we all encouraged and practiced preventative health measures for ourselves and our patients so that diseases could be diagnosed and treated early on to optimize care for all patients.”

Patient Perspectives

A patient with hypertension stated, “Medications that are prescribed and not covered by my healthcare plan cause delays in obtaining a different medication from the doctor or leave me with the option of paying out of pocket, which is sometimes impractical due to costs. Sometimes, waiting for authorization takes days and prevents me from starting a new medication right away. If the medicine is not authorized, I must contact the doctor and wait for another prescription.”

A patient with psoriatic arthritis stated, “Living with psoriatic arthritis, I often experience frequent medication changes, issues affording medications, especially the biological medications, challenges with insurance authorizations, and the costs of frequent medical visits, including labs. The restrictions that my insurance plan has on treatments that are covered often result in high co-pays or out-of-pocket costs, and time dealing with insurance companies can be overwhelming. Fortunately, my doctor and local pharmacist assist me by providing information about cost-saving programs, which can be helpful.”

Path Forward

As the discussion about healthcare continues, solutions to improving access and making healthcare more affordable for all patients are multifaceted and complex. It is essential to remember that the only way effective and practical solutions can be achieved is by working together with the common goal of delivering quality healthcare to all. Equitable and effective healthcare solutions can only be achieved through constructive, respectful, and collaborative efforts.