If my daughter doesn’t take her asthma medication, she’ll end up in the ER. I’m not exaggerating. Just ask Aaron, whom I’ve called at late hours asking for help caring for her. She tends to get attacks at night. If we can’t get her breathing well enough, there would be nowhere else to go but the ER. Once an ER visit resulted in a three-day hospital stay. This costs the system a lot of money, the patient a lot of concern, to say nothing of the heartache and lost productivity of her parents and loss of attention they can provide to the patient’s sister. We all want the patient to stay out of the ER.
I think about this every time I refill her medication at the pharmacy. Total monthly cost runs to about $45. And yes we use generics. That’s not a lot for my family, but it is enough to get my attention. It is enough that I think about cost every time she fails to breathe in her inhaled dose properly, forcing us to use another. That’s medication, and money, wasted. It’s enough money that it is likely many families with fewer resources would try to skimp, to skip doses, to go without filling prescriptions, and, yes, to run the risk of landing in the ER.
Asthma medication is exactly the type of health product that should be free, or nearly so, especially for low-income families. I cannot imagine many would take the meds for “fun”. I don’t think “skin in the game” causes patients to avoid overuse. All I think it does is risk more asthma attacks and more ER visits, even more deaths.
Value-based insurance design is a good concept. We have a long way to go in getting it implemented more thoroughly. I’d call breathing a merit good, something we all have a right to enjoy. Let’s not charge people for medication that permits it, particularly if doing so means we’re likely to pay vastly more if they don’t take their meds.
UPDATE: If you’ve come here from some blog quoting this post, you must read this.