SERIES: Healthcare in America #38, Julie Quest, This Is the Bronx

by Julie Quest, April 29, 2019

Profits And Patient Crises

As readers who have been following our healthcare stories might notice, there is a gap in our current system for patients with private insurance, and most others. When medications prescribed by doctors are not on the insurance “formulary,” patients must pay “out of pocket.” Recent studies report 73% of insured patients cut back on food or needed household items to pay for prescribed healthcare, almost half of insured patients have trouble paying out-of-pocket costs, and a quarter skip prescriptions because of cost.

Let us be clear: these are needed medications for acute or chronic conditions. When patients cannot afford them and don’t take them, many end up in a medical emergency, sometimes so dire their lives are threatened — as described in earlier stories, and in next week’s story, which focuses on the extortionate costs of generic drugs described below: patients with controllable ailments “bounced back” into emergency surgery and the ICU.

AREN’T PRESCRIPTION DRUGS SUBJECT TO MARKET FORCES?

Healthcare is often mistakenly described as a “market,” where industry profits and patient needs can co-exist — like markets for automobiles or cell phones — where competition between providers will lower costs and improve quality. But markets only operate this way when they are “efficient,” meaning that accurate, credible, reliable information about products and warranties exists. Healthcare, by its nature, isn’t like this. …

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