Reframing the unaffordability debate: patient responsibility for physician care

Public discussion suggests that rising out-of-pocket costs have dramatically reduced the value of insurance and led to patients doing without needed care. Our aim was to ascertain trends in patient responsibility for cost sharing.

We used data from an organization that serves over 78,000 healthcare providers and has access to visit-level data, including the amounts paid by patients. These practices are broadly representative of physicians and patients nationally.

We analyzed trends in patient obligations among a cohort of about 21,000 providers in 1078 practices who had used athenahealth software since 2011, including primary care physicians, obstetricians and gynecologists, surgeons, and some other specialists. Our analysis focused on what commercially insured patients pay out of pocket when seeking ambulatory care.

The average patient obligation for approximately 2.5 million primary care visits each year rose from $23.52 per visit in 2011 to $26.40 per visit in 2015, for an overall increase of $2.88, or about 3% annually. This rate of increase is moderate and below growth in overall healthcare spending during the same time period.

Average increases in patient obligations for outpatient visits in recent years have been fairly moderate, and multiple sources of survey data suggest that consumers' concerns about overall affordability are decreasing. The high cost of healthcare continues to pose challenges, both at the individual level and for society as a whole. Nevertheless, it is important that potential strategies to improve affordability are informed by trends in patient obligations.