High Deductible Maximizing Disparities and Minimizing Access to Care
This article started in response to a post about high deductible insurance. High deductible insurance is another element killing off basic health access and worsening disparities. As noted, $10,000 up front is more than enough to defeat the finances. High deductible plans do not work for basic services which are 90% of what is available locally where most Americans are most behind.
Negative discussions of high deductible insurance have long been present in conversations about Rural America, but the insurance expansion has made them more common overall, especially in counties lowest in health care insurance quality and health care workforce and social determinants.
And the worst private insurance plans may not pay for basic services or allow patients to see local providers. Others may not pay enough to cover the costs of delivering basic care as with Medicaid and some Medicare plans.
Another discrimination is 15% lower payments for office services and about 30% less for hospital services. Not surprisingly these practices and hospitals are stagnant, closed, or compromised by design. This also limits jobs, cash flow, and social determinants arising from health care dollars.
Their finances are worse in lower concentration settings, so they cannot pay as much for their health care - resulting in lower collection rates for local practices and hospitals.
They do not necessarily lack for employment as seen in the data, they just have the worst employers and therefore the worst benefits.
Similarly they do not lack for health insurance more than other Americans but they do have the worst public and private plans concentrated together.
All the above help to create and maintain shortages of generalists and general specialists which provide 90% of the local health services for these counties.
This reduces access to care and also tends to create a defeatism about health access. Local practices tend to have the worst finances and can be selective about the patients and plans that they accept - further worsening access. Local employers also may have insurance plans that are a poor fit with the local workforce as discovered by SERPA and other local organized practice efforts. Some employers can be influenced to reshape plans, but many cannot.
Even worse at the national level, designs force many billions more out of these 2621 counties lowest in health care workforce to pay for mandatory insurance and only about ten cents on the insurance dollar returns to support local health care services. This is mostly because the local health care workforce is absent from the location and gets paid less or the services needed are not available locally. This insurance expansion meaningless for most Americans most behind represents a massive new cause of disparities.
Meaningless insurance joins meaningless measurement abuse that also forces local practices and hospitals to sent out many more billions. These are extracted from lowest concentration settings to be sent to those in higher concentration locations and corporations. What good are measurements indicating downward outcome trends over time, when the measurement focus adds to disparities? What good are measurements that document lower outcomes for practices and hospitals that serve the Americans with inherently lower outcomes - and result in penalties and lower payments under value based or performance based designs.
Health insurance expansions, measurement worship, and health care financial designs all act to worsen disparities, jobs where needed, cash flow where needed, and social determinants.
The designers have never really considered the situations, conditions, resources, workforce, and disparities present in lower concentration counties - which is why they continue to worsen health care where most needed.