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How the U.S. Health Care System Fails Its Sickest Patients

The physician-assisted suicide law went into effect last year.Photograph by Richard Lautens — Toronto Star via Getty Images

Americans are not shy about their frustrations with the U.S. health care system—but in two new analyses, it’s the sickest patients who pay the price.

Researchers from the Commonwealth Fund, a non-profit health care firm, found patients with the most medical bills are also paying some of the highest out-of-pocket medical costs. This was true despite the fact patients were largely covered by public programs like Medicaid, Medicare, or private insurance.

The analyses compared the costs for Americans with “functional limitations,” such as difficulty completing basic tasks like shopping, as well as how much patients with multiple chronic health problems were spending on overall services vs. functional patients with multiple conditions.

Results showed that patients with limitations spent nearly three times as much on health care as patients who just had multiple chronic conditions, and more than four times that for all adults.

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Researchers concluded, however, that “this much higher level of spending care does not appear to buy consistently better access and care experiences.”

“Compared with all adults or adults with multiple chronic diseases only, adults with high needs were more likely to report having an unmet medical need and less likely to report having good patient–provider communication,” they added,


Insurance coverage also does little to drive down a patient’s out-of-pocket costs when compared to the general adult population, the authors wrote. They cited figures that show high-need adults spend nearly $1,700 out of pocket vs. the $702 the average adult spends. Those with multiple health conditions but no lifestyle limitations spend about $1,150.

The situation is especially difficult for adults with functional limitations, because their median income is about half the median income for both the overall adult population and the chronically sick who don’t have limitations.

Researchers believe that as health care moves away from a fee-for-service system towards one that bundles and coordinates care, medical providers should address this specialty group of particularly needy adults due to their high costs and financial strains.

“[It] is important to consider the unique needs of the subpopulation with functional limitations in combination with multiple chronic diseases when identifying patients for care models or care management programs,” they wrote.