Many Americans are being charged for preventive -- and supposedly free -- health care, new research shows, and those bills may keep them from booking appointments in the future.
Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients from receiving recommended care, said study lead author Alexander Hoagland, a Ph.D. student in economics at Boston University.
"The direct effect arises from patients who unexpectedly had to pay for a preventive service, and who are now less likely to return for repeated screenings," Hoagland said in a university news release.
"Indirectly, other potential patients who hear about these negative experiences may be less likely to seek out any screenings for fear of getting stuck with a bill," he added.
Hoagland and his colleagues analyzed 2018 national health insurance claims data for adults and children covered by employer-sponsored insurance. They found their total out-of-pocket costs for preventive services totaled as much as $219 million.
One in four patients who used preventive care had out-of-pocket costs, with an average cost of $20 to $23 per person each year.
Out-of-pocket costs varied widely depending on the type of preventive services and where patients lived, the study found.
Annual wellness visits accounted for a majority of the costs, at more than 35%.
Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections, as well as pregnancy-related services. Out-of-pocket costs for these services ranged from $3.63 to $293.28 per person, the researchers said.
Patients in the South and rural areas were more likely to be billed for preventive services. For example, average rates were less than 10% among patients in Massachusetts and Colorado, compared to more than 20% among patients in Mississippi and Alabama.
The study was published recently in the journal Preventive Medicine.
"The ACA enabled great strides in making preventive care free to patients, but the job is not done," said study co-author Paul Shafer, an assistant professor of health law, policy and management at the BU School of Public Health.
"As with any benefit that has to be implemented by thousands of different health insurance plans that are subject to the ACA, it won't always be perfect," Shafer said in the release. "We found that a majority of patients are receiving preventive care for free and those who were charged only paid about $20 or less. This is great news . . . but too many people are still footing the bill for care that most likely should be covered by their insurance plan."
The U.S. National Library of Medicine has more on preventive health care.
SOURCE: Boston University School of Public Health, news release, July 20, 2021