Response-The affordability of care

Response-The affordability of care

Responding to Hope

Hello Hope,

This is an interesting post. The affordability of care is a major factor that determines the accessibility of care. Affordability is related to overall care costs and correlated to poverty and income levels. The cost of care can be viewed more from the costs related to out-of-pocket care or the costs of insurance premiums. Insurance plays a critical role in shielding the population against unexpected healthcare expenditures. However, the lack of healthcare insurance coverage, especially for low-income individuals, risks missing out on essential care services, including screening for diseases that contribute to high healthcare expenditures, such as cancer, cardiovascular diseases, and other chronic diseases. Evidence from California and Washington has proved the potential of the Affordable Care Act (ACA) through price-linked subsidies to improve health coverage (Saltzman, 2019). However, better results can be achieved by providing relief on other competing expenditures such as food and housing.

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References

Saltzman, E. (2019). Demand for health insurance: Evidence from the California and Washington ACA exchanges. Journal of Health Economics, 63, 197–222. https://doi.org/10.1016/J.JHEALECO.2018.11.004

Responding to Melissa

Hello Melissa,

This is a great post. Your experience is a unique one that points to how some restrictive health insurance measures, such as restrictions on medications covered, contribute to disparities in access to certain healthcare services. Restricting medication coverage, especially in low-income settings where dependency is on public coverage, means a majority of the patients will not access certain medications that are not covered. This is not only discriminative; it risks worsening the health conditions under treatment, especially if it involves chronic diseases. Efforts focused on improving healthcare access must ensure that effective medicines and therapies are affordable and accessible to all patients, considering that medication affordability is a factor in adherence to treatment plans and health outcomes (Legido-Quigley et al., 2019). As a nurse, one has the duty to help the patient identify affordable alternatives or state and private programs that offer pharmaceutical assistance for chronic diseases.

References

Legido-Quigley, H., Naheed, A., Asita De Silva, H., Jehan, I., Haldane, V., Cobb, B., Tavajoh, S., Chakma, N., Kasturiratne, A., Siddiqui, S., Jafar, T. H., Clemens, J. D., Hasnat, M., Hameed, A., Khan, A. Z., Ranasinha, C., Fin-Kelstein, E., Bilger, M., Pryseley, A., Turner, E. (2019). Patients’ experiences on accessing health care services for the management of hypertension in rural Bangladesh, Pakistan, and Sri Lanka: A qualitative study. PLOS ONE, 14(1), e0211100. https://doi.org/10.1371/JOURNAL.PONE.0211100

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1. Hope
In the United States, healthcare disparities challenged individuals who needed healthcare-related services such as cancer screening or assistance with smoking cessation. 2010, the United States government initiated the Affordable Care Act (ACA). The goal of the ACA is to decrease the gap between those who receive treatment, medication coverage, and annual screening for preventative care (Zhao et al., 2020). Results of studies show that those of younger ages, challenged socioeconomic status, or minorities are at a disadvantage in receiving proper medical care, including preventative care, and are less likely to be screened for risk factors to prevent cancers like breast or colorectal as well as the prevention of progression in disease processes (Zhao et al., 2020).

Response-The affordability of care

In comparison, those with insurance are more likely to receive cancer screenings and care for preventative care. In contrast, those with less or a lack of insurance are more likely to succumb to the disease process, leading to higher mortality rates in uninsured patients (Zhao et al., 2020). With the ACA, the enforcement of easier access to health care allows for better patient outcomes, higher quality of care and life, and decreased medication costs (Zhao et al., 2020). In allowing for the equality of cancer screening, the mechanism for effectiveness and the ACA is healthcare insurance coverage, provider availability, and control of payment and delivery systems; the United States Preventative Services Task Force (USPSTF) rates preventative care from A to D which provides a guideline for preventative services as well as immunizations (Zhao et al., 2020). In doing so, all patients, based on age and development in life, are screened for preventable diseases such as colorectal, cervical, prostate, and breast cancers; screened for Hepatitis, Sexually Transmitted Infections like Gonorrhea, Chlamydia, and HIV, and many other potential medical conditions (Zhao et al., 2020). This is one way to achieve the gap for equal healthcare representation.
2. Melissa
Some of the patients may not have prescription coverage. Discuss some low-cost measures to help patients have access to medication. How can you or the staff determine the Rx cost for the patient?

My clinical rotation is in a very low-income urban area, where most of the patients are on public assistance, and the state covers their medical care. The problem with that is that the state is very strict about what medications they will cover and what ones they will not. As a result of this, we find that many of our patients with chronic conditions fail to take the medications that are prescribed and, therefore, fail to reach their treatment goals. One way the staff combats this is with drug samples. I have never seen samples given to the degree this office does. They also have a medical social worker in the office that they can consult to assist the patient in getting medication at an affordable price.

One good thing that this practice has is a real-time benefit tool (RTBT) built into its electronic health record (EHR) system. When a provider attempts to order a medication electronically, the EHR will produce an alert that tells the provider whether the medication is covered or not. Systems such as these are invaluable to providers and can help inform clinical decision-making concerning medications (Kiessling et al., 2022). However, knowing whether a medication is covered is only part of the puzzle. Even generic medications are too expensive for some people. A clinician must feel comfortable discussing medication costs and the patient’s ability to pay (2022). Another tool frequently used in my clinical rotation that helps facilitate these discussions is the GoodRx app. We always look up and compare the costs of a medication we are considering. The app shows where the price is the lowest, and then the patient can decide if the medication is affordable to them or not. Between the use of samples, the information in the GoodRx app, and the in-office social worker, we have improved patient compliance. There are still cases where the ideal drug is just out of reach, unfortunately.