The whole point of health insurance is protection from financial ruin in case of catastrophic, costly health problems. But a recent survey of people facing such problems shows that it often fails in that basic function.
The survey, of some of the country’s most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and co-payments; treatments their insurance won’t cover; and financial challenges — like lost work — that health insurance alone can’t address.
The New York Times, the Commonwealth Fund and the Harvard T.H. Chan School of Public Health used the survey to examine the sliver of the American population who use the health care system the most. To be included in the results, a respondent had to have been hospitalized twice in the last two years, and to have seen at least three doctors. In some cases, when patients had died or were too ill to answer questions, relatives who had taken care of them participated in their place.
Their experiences may serve as an early warning system for problems that all of us may face: Because the estimated 40 million people in this population visit doctors, hospitals, nursing homes and pharmacies the most, they are the likeliest to see the weak points in the health care system.
One of these is financial insecurity. Among people with health insurance, more than 20 percent had trouble paying for basic necessities. More than a quarter had bills in collection, and 13 percent had borrowed money as a result of their illness.
Sarah Miller, an assistant professor at the University of Michigan Ross School of Business, has studied how health insurance protects Americans from financial risk. The evidence is strong that coverage, particularly Medicaid, makes a difference. But she said it could still prove insufficient for people with complex needs.
“You’re kind of at a disadvantage as a consumer going against these big complicated systems that don’t always have your best interest at heart,” she said. “And I think that’s why there’s so much financial burden, even among people with private insurance.”
Health insurance, of course, provides little help for people who have to cut back on work because of their own illness or that of a family member. Mr. Berger had a steady income and good benefits when he worked as the housekeeping director for a retirement community. But once he became too ill to keep working, his income fell. Fifty-three percent of people in the survey said their work had been interrupted by illness, causing financial difficulties and compounding the burden of medical bills.