Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder.

Journal Article (Journal Article)

BACKGROUND: 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. METHODS: 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. RESULTS: 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. LIMITATIONS: Volunteer respondents may not fully represent the target population. CONCLUSIONS: 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.

Full Text

Duke Authors

Cited Authors

  • Madden, JM; Araujo-Lane, C; Foxworth, P; Lu, CY; Wharam, JF; Busch, AB; Soumerai, SB; Ross-Degnan, D

Published Date

  • February 15, 2021

Published In

Volume / Issue

  • 281 /

Start / End Page

  • 41 - 50

PubMed ID

  • 33290926

Electronic International Standard Serial Number (EISSN)

  • 1573-2517

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2020.10.033

Language

  • eng

Conference Location

  • Netherlands