Medically Approved

Medical cost madness - Recent rising prices and dropping usage

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Optum Perks Author

By Optum Perks Author

In the past, the argument for rising medical costs was that parents were taking their children to the emergency room and doctor’s office too often for issues that would resolve on their own. Expert analysts started a movement of preventative services and how-to articles so that parents would be better informed about their children’s health. It was a simple concept; if children aren’t going to unnecessary appointments and emergency room trips, then the overall cost would go down.

Until it didn’t work…actually, the reverse has happened. We see medical costs rising. According to the Health Care Cost Institute (HCCI) –

That year (2014) saw visits to doctors, the most common service for kids, as well as to radiology services and surgery services, drop by 0.4 percent from 2013. But spending on such visits in 2014 grew by 3.5 percent, HCCI's study shows. Outpatient visits by children shrank by 2 percent in 2014, but spending on such visits grew by 6.4 percent, according to HCCI.”

Naturists and Homeopathy have become generally more accepted in recent years and parents are becoming more informed about when children need to see a medical professional, but is that the only reason that medical visits have decreased? With the changes in medical insurance requirements, one would expect there to be more children with access to medical care, so that would mean more visits, right?

With some of the reasons for the Affordable Care Act already not proving true, will support of it decline even more? This could have major complications for some of the support for the restructuring of the insurance industry. Health care costs were supposed to decrease since more people would have insurance and affordable access to health care. Plenty of blame has been on the uninsured using services that they couldn’t pay for. Pricing contracts between insurance companies and providers were supposed to be renegotiated and lowered, but they continue to keep rising.

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The amount of money that comes out of the pocket instead of being paid by an insurance company was supposed to decrease. It would seem to be that insurance companies are taking advantage of the newer laws. They claimed and quoted that they would need to increase rates to compensate for more people using the system, but not too much because the premiums from healthier individuals would help cover the costs from sicker individuals that need more services.

Generally, sick chronically sick individuals meet their Deductible and Maximum-out-of-pocket (MOOP) limits annually. The MOOP is the maximum an individual or family must pay before insurance will pay for all covered services at 100%. This was $6,600 for an individual and $13,200 for a family in 2015. Most insurance companies had similar limits before the change, but there were exception plans. This increased to $6,850 and $13,700 in 2016. For more facts about the change and a breakdown of insurance lingo, click here.

To sum things up, medical costs are supposed to become more affordable, but they aren’t. While the experts haven’t come to a conclusion as to how using healthcare less relates to people paying more out-of-pocket annually than before, we can all agree that skipping needed visits to the doctor or emergency room is not the answer. It may not be the case, but when families cannot afford health care because insurance companies are less affordable than they have been in the past, there is a real issue. There is change coming.

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