Health Care Costs and Payment Models

Access to Health Care

Small Group Activity:

Small Group Activity:

• A 37 year-old man presents to his PCP with progressive dysphagia to solids, without weight loss
• No history of tobacco use or alcohol use
• Physical exam was normal. CBC, BMP, and LFTs were all unremarkable
• You tell the patient that you think should see a gastroenterologist and get an endoscopy
• The patient asks you what he can expect to pay out of pocket for this workup

Case: Out-of-Pocket Costs

• Work in groups to complete the chart using Health Care Bluebook
• Use healthcare.gov to find the charges for high deductible plan (i.e. IBC Bronze)
• How do out-of-pocket costs affect adherence to the treatment plan?

	GI Office Visit	Endoscopy
Charges
Out-of-Pocket Cost: Insurance with copay
Out-of-Pocket Cost: High deductible plan or uninsured
Out-of-Pocket Cost: Medicare

Case: Out-of-Pocket Costs

	GI Office Visit	Endoscopy
Charges	$424	$1,528
Out-of-Pocket Cost: Insurance with copay	$25	$25
Out-of-Pocket Cost: High deductible plan or uninsured*	$424	$1,528
Out-of-Pocket Cost: Medicare	$340	$1,222

*Until deductible of $7150 (federal maximum) paid, then no charge
*Uninsured patients may have discounted costs based on their income