The patient experience: Out-of-pocket costs are driving patients affordability and access challenges

Cynthia Hicks
Cynthia Hicks October 19, 2021

The patient experience: Out-of-pocket costs are driving patients affordability and access challenges.

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For too many Americans, simply having health insurance isn’t enough to afford and access the care they need. Our inaugural Patient Experience Survey (PES) reveals how rising out-of-pocket costs can exacerbate affordability issues and hinder access to care. This especially holds true for the sickest and most vulnerable patients.

Here are four things you should know.

1. 3 in 10 Americans who have insurance still face a financial barrier to care, including trouble paying medical bills or other out-of-pocket costs. Simply having health insurance coverage is not always enough for Americans to afford their care.


2. Hospital bills cause the most financial strain and concern. 30% of Americans with problems paying medical bills in the past year say hospital bills were the largest share of these costs. Moreover, 24% of Americans would be “very worried” about their ability to pay for hospital bills.

3. Americans report difficulty paying insurer out-of-pocket costs, such as deductibles and coinsurance, which can lead people to abandon their medicines. More than half (52%) of patients with a high-deductible health plan report not taking their medicines as prescribed by their doctor in the past year (also known as non-adherence). And 87% of Americans with medical debt report nonadherence in the past year.

4. The most vulnerable patients are more likely to experience several barriers to access at once. 31% of Americans reporting poor health and 26% of patients with disabilities report forgoing needed care, have trouble paying medical bills, have out-of-pocket costs that are more than they can afford, have no savings to cover medical expenses and worry about accessing and paying for care.

Insurance should work like insurance. When it comes to solutions, a majority of patients (59%) prioritize lowering out-of-pocket costs over their premiums. We need solutions that make insurance work like insurance by covering more medicines from day one, making out-of-pocket costs more predictable, ensuring cost-sharing assistance applies to deductibles and sharing negotiated savings with patients at the pharmacy counter. Read the full Patient Experience Survey here and learn more about patient-centered solutions at PhRMA.org/BetterWay.

Topics: Burden on Patients, Out-of-Pocket Costs, Polling