High Costs are Driving People Away from Necessary Healthcare

April 24, 2018

U.S. health care costs keep rising, evidence is mounting that these high prices are instrumental in people skipping physician visits. In 2016, healthcare costs amassed a person cost of more than $10,000 a year. According to one recent national poll conducted by the University of Chicago and West Health Institute, over the past 12 months, 44% of Americans said they didn’t go to the doctor when they were sick or injured because of financial concerns. An additional, 40% said they skipped a recommended medical test or treatment.

Also, the U of C/West Health Institute study found most people who are delaying or skipping care actually have health insurance. Some 86% of those surveyed said they’re covered either through their employer, have insurance they purchased directly, or through government programs like Medicare and Medicaid. This change in behavior by insured individuals is at least in part driven by rising out-of-network fees and higher deductibles, which both contribute to higher out-of-pocket costs.


The poll found Americans fear large medical bills more than they do serious illness. The data showed 33% of those surveyed were “extremely afraid” or “very afraid” of getting seriously ill. About 40% said paying for health care is more frightening than the illness itself.  Additionally, the survey found 54% of those polled received one or more medical bills over the past year for something they thought was covered by their insurance, and 53% said they received a bill that was higher than they expected.


“There have been so many changes in the health care landscape in the United States that this news is not entirely surprising,” Cleveland Clinic president and CEO Tom Mihaljevic told CNBC’s “On the Money” in a recent interview. However, Mihaljevic warned that skipping visits or treatment can be counterproductive. “One of most important consequences of skipping medical care or delaying care ultimately impacts the quality of care, impacts the outcome,” he said. “Untimely visits or delay of visits to the physician ultimately leads to the increased cost of care.”


The Cost of Care


It is helpful to look for parallels between the rising costs of general healthcare and its impact on hearing healthcare.  For example, the cost of hearing aids, by far the largest out-of-pocket expense for individuals with hearing loss, averages about $2000 per instrument. Although a July 2017 JAMA Otolaryngology report by Valente and Amlani infers that cost is not the primary barrier to hearing aid adoption, common sense suggests a sizeable number of older Americans simply cannot afford hearing aids.


According to the June 2016 NASM report on affordability and accessibility in hearing healthcare, 33% of Americans have an annual income of less than $35,000, and 50% of Americans aged 65 and older have an annual income below $24,150. Given other essential monthly living expenses, such as housing, food, utilities and medications, the out-of-pocket expenses of hearing aid acquisition seem out of reach for many.  


Like the delay in care cited by Mihaljevic, delaying the use of hearing aids is likely to result in negative consequences for older adults who cannot afford them or access them because they cannot get to scheduled appointments.

One approach to combating rising health costs is the “standardization of care.” According to Cleveland Clinic, Mihaljevic, “When we reduce the variability of the way we take care of patients, we manage to decrease the cost and at the same time improve the quality of care that we provide. We firmly believe digital technology is going to have a transformative effect.” Among the Cleveland Clinic initiatives is a partnership with IBM Watson to use big data to help clinical decision making.


Standardizing (Hearing) Healthcare


Hearing healthcare professionals would be wise to use similar strategies to lower the overall cost of care. One recently formed professional group, the Audiology Practice Standards Organization (APSO) believes that developing and adopting practice standards is key to the future growth of our profession. According to information on their website, the goal of APSO is to collaborate with all organizations in the profession to develop and educate colleagues about practice standards. No mention, however, is made on the APSO website about how standardization of audiology practice standards could result in lower costs for patients.

In addition to standardization of care, tele-medicine tools have the potential to lower costs as well as improve access to services. At the recently concluded American Academy of Audiology convention in Nashville there were a few start-up companies demonstrating remote web-based hearing testing (one example is the Israeli company, Koalsys) and alternative amplification products sold at a lower price point (Alango Technology, also from Israel) and intended for use by older adults.


Several of the leading hearing aid manufacturers and equipment distributors also now offer hearing aids at lower price points as well as new features such as remote programming and adjustment via the internet that has the potential to lower the cost of care.


As the overall cost of care continues to rise, all healthcare professionals, including audiologists and hearing instrument specialists will be tasked with ensuring they hold their costs in check and do not price themselves out of the market. As the recent University of Chicago and West Health Institute poll indicates, high prices keep people out of the doctor’s office – even for necessary care.


*featured image courtesy MSU

  1. I am not disputing Brian’s information or disagreeing with the premise of standardizing health care procedures in order to reduce costs. I’m not even disagreeing with the likelihood that there are those who actually cannot afford certain health care procedures, including higher cost HAs. For those, we have a social and moral obligation to take care of those who are truly in need.
    I would like to see, though, an assessment of the difference between “I can’t afford it” vs. “I don’t want to afford it”. I learned 35+ years ago that there is usually a distinct difference between “annual income” and “net worth”. I have not seen a report about health care concerns and cost addressing this comparison.
    For example, the comment above, “50% of Americans aged 65 and older have an annual income below $24,150” gives us no information about their net worths. It has been said that senior citizens make up 20% or the U.S. population and hold 80% of our country’s spendable income. So, it is conceivable that millionaires who are retired and living on SS and some interest from their investments and who can actually afford health care and/or HAs, will come in and tell us that they live on a “fixed income”. The implication is that they can’t afford the care. Those who say they can’t afford care may be actually telling us that they don’t want to afford the care. We seem to have developed the mindset that our insurance should pay for the entire amount of a procedure/treatment. If it doesn’t, I’ll take the lower cost option so my insurance covers everything and I don’t have an out-of-pocket expense. Then I’ll complain about receiving lower level care.
    I would like to see a more honest assessment in these studies and have them also ask questions like: a) what is your net worth, b) how many cars/trucks do you own (make, model, year), c) how much is your house(s) appraised at, d) how many TVs do you own, e) how many cell phones do you own, f) how much is your cable bill per month, etc.? Then, correlate and integrate that information in the overall evaluation. Over the years, I have found in general that people will afford whatever they want, which does not necessarily mean whatever they need. I have no problem discussing issues on how to reduce costs, but let’s be honest in collecting data that is moving us in that direction. Analysis based on incomplete or inaccurate information is not a true analysis.

    1. I think you make a very good argument, Larry. Although, one does have to take into account that you can have a decent net worth, but your liquid assets (i.e. cash) can be very limited.

      If you live in San Fransisco, for example, and purchased a home in the 60’s or 70’s and now your home is worth well over $1M, but this doesnt necessarily mean you have boatloads of cash in the bank to spend on healthcare… it’s a tricky thing to parse out. But to your point, I agree that “I dont want to afford” is likely the culprit in the vast majority of these situations.

Leave a Reply