Troubling health care trends on the rise amid inflation frustration

The last time inflation was an issue, I was in elementary school. I remember it in a hazy sort of way from watching the evening news with my dad.

At the time, inflation was driven by an oil crisis that prompted long lines of cars at gas stations and my dad to finally trade in our four-door sedan for a fuel-efficient compact car. While there was less space in the back seat for my brother and me, the improved gas mileage meant we could afford a few more groceries.

Inflation felt like a distant memory for decades, but it’s back in a big way. With consumer prices up 9% this summer over the same time last year, I can’t help but think about how this financial pinch affects patients. When costs are up but incomes haven’t kept pace, discretionary spending suffers.

Unfortunately, health care falls into the discretionary realm for many families. When people are struggling to find space in their budgets for necessities like groceries to feed their families and gas to get to and from work, health care becomes expendable. These painful choices lead to deferred and delayed care, and health care spending only continues to creep higher.

There’s never a good time for inflation to spike. But as health care costs have been rising consistently for decades and many people put off care during the pandemic, right now feels like particularly bad timing. Benefit advisors and employers have tried to keep employee health insurance contributions more manageable by shifting cost-sharing to patients, but health care choices are becoming more difficult for patients to handle with inflation squeezing consumers’ wallets.

A shocking number of Americans have struggled to pay for care over the past decade. A recent report from KHN and NPR found that 41% of U.S. adults have some form of health care debt. People pay for care via hospital payment plans, 401(k) loans, or borrowing from friends and family members. As a result, some of the statistics describing medical debt might even be underreported. This backdrop provides the kindling, and inflation is a lit match ready to set our health care debt problems ablaze.

The high costs of delayed care

As long as prices and deductibles are high, people will continue to delay and put off care that does not seem strictly necessary. While a broken arm or a high fever will demand a visit to an ER or urgent care, more routine medical services can be put out of mind for a time.

This is a dangerous calculus. A man with high blood pressure has few, if any, symptoms. A woman with slightly elevated blood sugars won’t notice her glucose levels creeping up over time. It’s only when the high blood pressure causes a heart attack or the diabetic patient begins feeling numbness in their toes that these problems surface in a way that demands medical attention.

I have deeply personal experiences with the consequences of delayed care. My parents owned a restaurant in my small hometown in central Missouri. In the lead up to the financial crisis of 2008, the restaurant struggled. My parents barely made ends meet, and they saw things like a visit to the doctor as a luxury. I told my parents that their health was important to me and that they needed to keep seeing their doctors, but they would wave me off and dismiss my concerns.

“You’re a doctor who sees sick people all day long,” they said. “That’s not us. We’re fine. Take care of your patients — we’ll take care of ourselves.”

When my dad finally visited a doctor and described symptoms he’d been experiencing, including excessive thirst and the need to go the bathroom all the time, the physician did bloodwork. My dad’s blood sugar was over 400 mg/dL (a normal level is below 100 mg/dL). The doctor prescribed some oral medications and asked my dad to stay in close touch with him.

But with the restaurant struggling, Dad figured he had better things to spend his money on (e.g., gas for the truck, mortgage payments, and groceries). The Affordable Care Act wasn’t law back then, and insurance was hard to get for somebody with health problems like my dad. And even if it had existed, he likely would have had a hard time paying his premiums.

When he finally did go back to the doctor — years later — the news was not good. His sugars continued to be incredibly high, and his kidneys sustained severe damage. Things escalated over the coming months, and he was on dialysis within a year. Three times a week, he had to go to the hospital and get hooked up to machines for three or four hours at a time.

The restaurant closed a few months into the recession of 2008. In 2015, my dad died while waiting on a kidney transplant list. Had he not delayed care, I’m sure he would’ve had a better outcome.

I share this story because it underscores my personal interest in making sure people get medical care when they need it. I’m alarmed by rising out-of-pocket medical expenses — especially with inflation and wage stagnation making it harder for people to afford care.

Helping workers help themselves

Despite these challenges, I have hope that things will improve. Employers and benefit advisors will rise to the occasion and help others manage these difficult factors. I see three key ways advisors and employers can work together to help employees deal with rising health care costs amid record-setting inflation.

1. Embrace the power of digital health tools. A variety of digital health tools exist that can help people access and manage care while controlling overall spending. Condition-specific tools exist for nearly every common chronic disease. Whether someone has high blood pressure, anxiety, or even a rare genetic condition, chances are there is a digital tool that can help manage that condition, improve outcomes, and lower costs. Employers and advisors should help workers find and use those tools.
2. Adjust benefit design to this changing reality. While high deductibles and hefty out-of-pocket maximums might be here to stay, this is a bad time to increase these amounts to even more stratospheric levels. To help employees manage already high out-of-pocket expenses, employers should offer spending accounts and other solutions that give employees the flexibility to pay their health care expenses over time. We can’t rely on hospital financing programs and consumer loans to manage this debt. While they’re great resources, they only help people after they decide to get care. Unless a person knows in advance that they have a way of paying for their care, they will likely put off the service until their condition worsens or their finances improve. That leads to more intensive and costly medical interventions to help the person heal.
3. Make preventive care a priority. We must continue to urge employees to see their doctors for routine checkups — and to manage their chronic conditions. COVID-19 has already put us behind in this regard, as plenty of people put off care because they understandably didn’t want to visit a doctor’s office during a pandemic. We can’t continue digging this hole deeper by making routine care too expensive for people to afford. Employee campaigns and incentives should encourage routine care, and employers should help subsidize this care whenever possible.

Read more: How employers will control high health care costs in 2023

The coming economic climate will make it hard for many to get the care they need in 2023. If leaders don’t pay attention, medical costs will go up even faster than they have over the past decade as delays in care lead to worsening chronic conditions. If employers and benefit advisors work together to address these issues now, then they can help patients take charge of their health and not delay or skip their necessary health care.

Jay Moore, M.D., is the chief clinical officer of Paytient, a company on a mission to help people better access and afford care.