Interrelation of preventive care benefits and shared costs under the Affordable Care Act (ACA).

Robert Brent Dixon,Attila J Hertelendy

doi:10.15171/ijhpm.2014.76

Abstract

With the implementation of the Affordable Care Act (ACA), access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures. Even with improved access to preventive care benefits, cost-sharing of other health services remains a major component of insurance plans. In order to treat identified conditions or diseases, cost-sharing comes into play. With the greater adoption of cost-sharing insurance plans, expenditures on the part of enrollee are anticipated to rise. Once the healthcare recipients realize the implication of early identification and resultant treatment costs, enrollment in preventive care may decline. Healthcare legislation and regulation should consider the full spectrum of care and the microeconomic costs associated with preventive treatment. Although the system at large may not realize the immediate impact, behavioral shifts on the part of healthcare consumers may alter healthcare. Rather than the current status quo of treating presenting conditions, preventive treatment is largely anticipated to require more resources and may impact the consumer's financial capacity. This report will explore how these two concepts are co-dependent, and highlight the need for continued reform.

Highlights

Statement of the issue and background The need for healthcare access and cost management of healthcare programs is essential for a healthy community and sustainable health system
The insured patient has shared cost responsibilities related to non-preventive services that may be recommended as part of a preventive care visit
According to the recent health system reform legislation, insurance beneficiaries are entitled to preventive care procedures that are recommended by the U.S Preventive Services Task Force without costsharing (2,5,6)

Summary

Dixon and Hertelendy

Current situation Coverage of preventive care services aims to reduce the amount of undiagnosed or untreated conditions. In order to achieve higher efficacy and return on investment in preventive care, those services with minimal evidence of effectiveness should be held to an assessment process (13) This strategy will help preserve healthcare dollars for those procedures with known benefit. In efforts to address concerns related to rising healthcare costs, employers are deploying strategies aimed at reducing employee absenteeism while improving production and corporate morale (15) These programs address individual behaviors including physical activity, exercise, weight loss, and smoking cessation (15). Value-based cost-sharing occurs when the patient seeks treatments, medications, procedures, and other services that yield the highest value compared with other options. This has been largely applied to medications (16). This leads to the need for overall reduction in costs and translating those cost reductions into affordable prices for the patient’s cost share

Findings

Discussion and recommendation

Conclusions