Patient Affordability & Out-of-Pocket Cost (OOP)
Patient Affordability refers to a person’s ability to afford treatment, testing, hospitalization, and other health care costs. There are significant costs associated with medical care, and some patients are unable to cover these costs, or covering them causes the patient to choose between health care and other significant needs such as food or housing. This can be the case particularly when patients have life-long conditions which can lead to co-morbidities. Some conditions are genetic and more than one person in the family can need access to health care at the same time. Patients and their families can find themselves in a predicament where the cost of treatment is impoverishing and unaffordable.
While insurance can help bring the direct cost down, premiums are on the rise, and in addition, there are still co-pays, deductibles, and out-of-pocket costs. Out-of-pocket costs are costs that will not be reimbursed or covered by other sources; the patient must pay them. Patients with chronic health conditions are often on more than one costly medication. This can lead to extreme out-of-pocket costs with some patients having to select which of their medications they can afford each month and declining health which further impacts the healthcare system and their need to utilize it. You can read more about affordability in a KFF article. You can read here about high out-of-pocket costs HERE.