Tags: Health Topics | Healthcare Reform | health insurance | healthcare | doctor patient rights project

Doug Schoen: Cost-Cutting Insurance Companies Creating Healthcare Crisis

Doug Schoen: Cost-Cutting Insurance Companies Creating Healthcare Crisis
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By Tuesday, 15 August 2017 01:37 PM Current | Bio | Archive

While media coverage of health care issues tends to focus on the plight of the uninsured, millions of Americans with health insurance have problems accessing the care they already paid for. Despite a widely-held belief among consumers that medical decisions should be left to patients and physicians, insurance companies commonly employ cost-cutting measures that delay or deny coverage of certain treatments for insured Americans.

Starting with the rise of managed care in the 1990s, health insurers developed several practices intended to keep costs down by limiting specific treatments and prescriptions. These included prior authorization requirements, which allow insurers to review prescriptions prior to agreeing to cover them, and step therapy protocols, which require patients to try cheaper medications (and document their failure) before the insurers will pay for the one the doctor originally prescribed. These practices can result in significant delays for patients while their insurer decides whether approve a certain treatment. In some cases, coverage is denied outright.    

Surprisingly, little research has been done to quantify the prevalence of coverage denials and the burden they create for insured Americans. To help fill this research gap, I was recently commissioned to conduct a poll on healthcare access for the Doctor-Patient Rights Project (DPRP), a coalition of patients, physicians, companies and advocacy groups founded earlier this year to preserve the doctor-patient voice in treatment decisions.

The results of DPRP’s survey illustrate just how widespread insurance company interference in treatment decisions has become. One in four patients (24 percent) with a chronic or persistent condition we surveyed reported having been denied coverage at least once for a prescribed medication, test or procedure to their condition. Seventy percent of those patients described their chronic or persistent illness as “serious.”

Nearly 60 percent of the patients who were denied coverage by their insurance provider said they had been denied treatment more than once. More than one third of denied patients — up to 43 percent of whom described themselves as being “in poor health” — ultimately had to put off or skip treatment altogether, and 29 percent reported that their condition worsened while their insurer deliberated over whether to approve or deny coverage. Altogether, we estimate that as many as 53 million Americans may be at-risk for being denied coverage of a prescribed treatment for a chronic or persistent condition. 

These shocking figures fly in the face of the near-universal belief — shared by 91 percent of the consumers DPRP polled — that insurance providers should not have ultimate authority over medical decisions. 88 percent, in fact, said doctors should be able to control treatment decisions without interference from insurers.

When insurer interference is so widespread, it should come as no surprise that almost two thirds of the insured Americans DPRP polled also said that health insurance companies today are failing their customers. Moreover, 38 percent said their satisfaction with their insurer had declined over the past five years. 

Insurance company coverage denials may not receive the same level of attention from the media as rising premiums or coverage for pre-existing conditions, but, for millions of American consumers, they are the primary factor in their widespread dissatisfaction with the state of our nation’s health care system.

DPRP’s research is by no means the final word on the issue of health insurance coverage. But it does highlight the urgent need for more official data on whether insurance companies’ cost-cutting measures are preventing insured Americans from getting the healthcare they have paid for. Without this research, the debate over how best to overhaul the nation’s health care system misses entirely this hidden healthcare crisis.   

Doug Schoen is a Democratic pollster, strategist, and best-selling author.

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While media coverage of health care issues tends to focus on the plight of the uninsured, millions of Americans with health insurance have problems accessing the care they already paid for.
health insurance, healthcare, doctor patient rights project
Tuesday, 15 August 2017 01:37 PM
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