Northeastern University School of Pharmacy, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.
J Affect Disord. 2021 Feb 15;281:41-50. doi: 10.1016/j.jad.2020.10.033. Epub 2020 Oct 15.
Cost-sharing disproportionately affects people with chronic illnesses needing more care. Our qualitative study examined lived experiences navigating insurance benefits and treatment for bipolar disorder, which requires ongoing access to behavioral specialists and psychotropic medications.
Forty semi-structured telephone interviews with individuals with bipolar disorder and employer-sponsored health insurance, or their family caregivers, explored health care needs, coverage details, out-of-pocket (OOP) costs, and perspectives on value. An iterative analytic approach identified salient themes.
Most individuals in our sample faced an annual insurance deductible, from $350-$10,000. OOP costs for specialist visits ranged from $0-$450 and for monthly psychotropic medications from $0-$1650. Acute episodes and care for comorbidities, including medication side effects, added to cost burdens. Medication nonadherence due to OOP costs was rare; respondents frequently pointed to the necessity of medications: "whatever it takes to get those"; "it's a life or death situation." Respondents also prioritized visits to psychiatrist prescribers, though visits were maximally spaced because of cost. Psychotherapy was often deemed unaffordable and forgone, despite perceived need. Interviewees cited limited networks and high out-of-network costs as barriers to specialists. Cost-sharing sometimes led to debt, skimping on nonbehavioral care or other necessities, exacerbated or prolonged mood symptoms, and stress at home.
Volunteer respondents may not fully represent the target population.
Many people with bipolar disorder in US employer-sponsored plans experience undertreatment, hardship, and adverse health consequences due to high cost-sharing. More nuanced insurance benefit designs should accommodate the needs of individuals with complex conditions.
自付费用的负担不成比例地影响到需要更多护理的慢性病患者。我们的定性研究考察了个人在使用保险福利和治疗双相情感障碍时的亲身经历，该病需要持续获得行为专家和精神药物治疗。
对 40 名有双相情感障碍且参加雇主赞助的医疗保险的个人或其家庭护理人员进行了半结构化电话访谈，以探讨医疗需求、保险覆盖范围、自付费用和对价值的看法。迭代分析方法确定了突出的主题。
我们样本中的大多数人都面临着每年的保险免赔额，从 350 美元到 10000 美元不等。专科医生就诊的自付费用从 0 美元到 450 美元不等，每月精神药物的自付费用从 0 美元到 1650 美元不等。急性发作和治疗共病，包括药物副作用，增加了成本负担。由于自付费用而导致的药物不依从很少见；受访者经常指出药物的必要性：“不惜一切代价获得这些药物”；“这是生死攸关的情况”。受访者还优先考虑看精神科医生，但由于费用原因，就诊时间间隔最长。尽管有需求，但心理治疗往往被认为负担不起，因此被放弃。受访者提到网络有限和高额的网络外费用是寻求专科医生的障碍。自付费用有时会导致债务、削减非行为护理或其他必需品，加剧或延长情绪症状，以及家庭压力。
志愿者受访者可能无法完全代表目标人群。
由于高自付费用，许多参加美国雇主赞助计划的双相情感障碍患者的治疗不足、困难和健康后果不佳。更细致的保险福利设计应该适应患有复杂疾病的个人的需求。
