My bipolar disorder was under control when I stopped taking my meds. Three months later I was in the hospital following a suicide attempt. I found out it costs a lot less to stay alive.
I was going to write about healthcare expenditures with an article entitled, “How the High Cost of Healthcare is My Fault.” In it, I would briefly outline my experience with mental illness and detail the cost of caring for this illness, which, at present, including medication and doctor visits, totals about $3,000 per year.
In the summer of 2002, I chose to stop taking my medicine the way my doctor directed me to take it, and then I stopped taking my medicine at all.
As a result, my illness became an emergency. Nine hours in the ICU, four days in a private room, and two more weeks of psychiatric in-patient care brought a bill that topped $65,000.
That’s the cost of over 20 years of care eaten up by just a few weeks of my irresponsibility.
Cost that the healthcare industry, including my insurance company, would not have had to bear if I had only taken my medicine as directed. It then seemed easy for me to extend this problem to all patients with any chronic disease.
If patients would comply with their prescribed treatment regimens the cost of healthcare in the United States would go down. A lot. As a matter of fact, a New England Healthcare Institute study of healthcare costs in the United States pegged the added cost of care due to patient noncompliance at $290 billion.
That’s 15% of the country’s total annual healthcare cost.
A Medco Study found that only 50% – 65% of patients with chronic conditions take their medication as directed.
When noncompliant a person does not take his or her medicine as prescribed. This often leads to their condition worsening, and then results in higher costs of doctor visits, emergency room visits, and hospitalizations.
On the other hand, medication compliance can significantly reduce these costs.
According to Medco, for every dollar spent on diabetes medication medical cost savings are $7.00, for every dollar spent on high cholesterol medication medical cost savings are $5.10, and savings of $3.98 are found for every dollar spent on prescription medication for high blood pressure.
So if simply taking one’s medicine can lead to lower total healthcare costs, why are so many patients noncompliant?
Reasons for noncompliance include side effects, lack of continuing symptoms, identification with the disorder and yes, irresponsibility. But cost may loom largest.
I have always had health insurance. The co-payment for my medicine is $49 per month when I’m stable (it was higher, but the drugs went generic). It goes up during rough patches. I’m responsible. I pay it. I’m well.
I thought, perhaps I adhere to my treatment regimen because I am so heavily invested in it. Maybe if everyone paid a larger share of his own healthcare bill compliance with treatment would increase.
Maybe personal responsibility, sacrifice when necessary, and more participation by each individual in the cost of his or her care would improve compliance rates and reduce the overall cost of healthcare.
But I’m one of the fortunate ones. I can afford to think that way.
As costs increase, fewer can afford to pay them. A study from the National Bureau of Economic Research finds that an increase in medication co-payments from only $6 to $10 results in a 6.2% increase in noncompliance and a 9% reduction in the share of fully compliant persons.
The same study finds that increases in coinsurance lead to even larger increases in noncompliance. As for the uninsured, the American Public Health Association has found that 89% have not filled a prescription due to cost.
What was lost on me and those who argue for more skin in the game was some very simple economics. If each individual pays less for their prescriptions, compliance increases. Then the nation and insurance companies pay less of a total healthcare bill as costs related to noncompliance go down.
Unfortunately, the trend in employer provided health insurance is for each individual to pay higher co-pays or coinsurance. As these costs go up out-of-pocket expenses may exceed one’s ability to pay. The choice? Noncompliance or increased debt and possible bankruptcy.
High deductibles and higher co-payments charged by insurance companies against each individual will only make the problem worse.
Paradoxically, as cost driven noncompliance pushes total healthcare costs to each individual higher, these same insurance companies may find themselves less profitable over the long run as they face the higher cost of complications caused by medication noncompliance.
Maybe we all would benefit if medication just cost less.
As for my, and others’, idea that if people pay a larger percentage of their healthcare costs they will live healthier, more compliant, lives, the truth is that health and compliance can be beyond the reach of some people’s ability to pay as the system is currently structured.
Low cost prescription benefits must be considered as we approach ideas to lower total healthcare costs. Higher costs to individuals for medication leads to higher rates of noncompliance, which leads to a higher national healthcare bill that, one way or another, we all must share.