HEALTH MATTERS: Co-pays, deductibles are here to stay

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. I’m annoyed by the co-pays and deductibles I have to pay to get medications and various health services. That’s why I have insurance! Why do insurance companies often insist on them?

A. Let’s start by defining what we are talking about. These terms refer to payments by a patient who has health insurance. A deductible is a fixed amount the patient has to initially pay out of pocket before insurance kicks in and absorbs any further medical costs. A co-payment (and the related concept of co-insurance) is a charge the patient has to pay in order to get the insurance company to pay the remainder of the bill. Co-payments, by the way, are fixed dollar amounts (like $10 per prescription), while co-insurance is a percentage of the bill (like 10 percent) the patient has to pay.

There are two reasons why insurance companies use co-pays and deductibles. The first and obvious one is the added revenue generated from the patient reduces the amount the insurance company has to pay. But it turns out this is not the major reason for these patient payments.

The primary reason is that requiring a patient to pay some of the bill reduces his or her consumption of health care services, and thus reduces the overall payments the insurance company has to make. This is because insurance “shields” patients from many of the costs of health care, and therefore patients tend to use more health care services if insured than they would if uninsured.

So, the theory is that, by using deductibles in particular, patients will avoid seeking medical care for minor conditions (for example, a simple cold that will get better by itself) while still having the financial protection of insurance for major illnesses (such as pneumonia, for example). But the principal problem with this theory is that patients are not particularly good at distinguishing minor from serious medical conditions — and we shouldn’t necessarily expect them to be. Nevertheless, deductibles and co-pays are here to stay.

Q. I am an older woman with the embarrassing problem of urinary incontinence. What can I do to help it? Do medicines work?

A. Unfortunately, you share a problem many older women have. As you know, it is embarrassing, inconvenient and often demoralizing. The usual treatment includes pelvic muscle and bladder training, and often medication to treat the overactive bladder that can contribute to the problem. There are about a half-dozen medicines commonly used, and they do seem to help some patients. However, a recent study found that their overall benefit is relatively small, although some women do achieve continence with their use. Side effects are common, and more than half the patients on these medications stop taking them because of the adverse effects. Some of these — even if rare — are quite serious, including hallucinations, extra heartbeats and even sudden death. So the bottom line is that while medicine may reduce your incontinence, you may not be able to tolerate the drug. In treating some medical conditions, the benefits of the medications are so important they far outweigh the risks; unfortunately, that is not so with the usual medications used to treat urinary incontinence.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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