Key Findings of PAF’s 2014 Patient Data Analysis Report Illustrate Startling Impact of Medical Debt on Majority of Patients Served

 Newly Released Analysis Notes More Than 50% of Patients Will Struggle to Pay Medical Debt This Year

LIGHTNING RELEASES: WASHINGTON, DC (4/30/2014) - Medical debt remains the most frequently reported health care difficulty for patients, according to data released today by the Patient Advocate Foundation (PAF) – a leading national non-profit patient advocate organization that provides patients who have chronic, debilitating and/or life-threatening diseases with one-on-one, sustained case management. PAF released the data through its annual Patient Data Analysis Report (PDAR), a quantitative analysis of information on 88,364 patients who sought help from the organization in 2013.

“The Patient Advocate Foundation’s annual PDAR continues to serve as an invaluable tool to policymakers, stakeholders and health care providers as they evaluate emerging trends and develop appropriate solutions to improve the health care system,” said Nancy Davenport-Ennis, Founder and Chairman of the Board of Directors for PAF and the National Patient Advocate Foundation (NPAF). “This data represents the experiences of thousands of Americans who struggled to obtain and afford health care, reaching out to our case managers for help who then documented their efforts.”

“The mounting crisis of medical debt in America is causing untold stress, exacerbating illness and devastating the financial futures of millions of individuals and families,” stated Alan Balch, CEO of PAF and NPAF. “The majority of patients who reach out to us for help with health care issues are drowning in medical debt and need a life raft.  As the nation’s leading patient advocacy organization, we pledge to work with policy makers on behalf of the patients we serve by advocating for common-sense solutions to help ease the burden of crippling medical debt.”

In addition to the medical debt crises experienced by PAF patients, 40 percent of cases documented problems with accessing health care. The PDAR documents services necessary to resolve a host of health care access issues, ranging from insurance denials and identification of coverage options for the uninsured to navigating and accessing the newly implemented Affordable Care Act (ACA) Marketplaces.

Key Findings in the PDAR

- While over half (57.2%) of PAF patients sought assistance resolving Medical Debt Crisis issues in 2013, the proportion of patients seeking Healthcare Access Issues has continued to increase and represents 40.6% of all issues, an 8.8% increase from 2012.

- Insurance issues increased from 16.2% in 2012 to 18.9% in 2013 as PAF patients sought assistance enrolling in the state health insurance exchange marketplaces launched on October 1, 2013.

- Two of the top 10 insurance resolution types and 13 insurance resolution types overall related to the ACA and state health insurance exchange marketplaces.

- Commercially insured PAF patients represented the largest insurance category at 33.0% (an increase of 7.1% from 2012), shifting uninsured to the second largest insurance category.

- Among PAF patients, ethnic diversity continues to increase as over one-third (36.1%) of PAF patients in 2013 were non-Caucasian (an increase from 35.8%) and the proportion of Hispanic/Latino patients increased by 12.7%.

- The proportion of Caucasian PAF patients (63.9% in 2013) has decreased every year since 2010 and is now aligned with the national average of 63%.

- For the first time since 2011, the largest proportion of insurance access issues for pharmaceutical agents was related to the denial of necessary pharmaceutical prior authorizations (23.5%), representing almost a three-fold increase in the proportion of patients representing this issue from 2012.

  • Among pharmaceutical agent resolutions, overturned denials of pharmaceutical prior authorizations increased five-fold from 2012 to 2013, and now represents the second most common resolution.

- PAF case managers provided services to patients with 326 different diagnoses, 16 more conditions than reported in 2012.

- 21.2% of patients reported more than one medical condition across all categories. Multiple medical conditions will often increase the patient’s out-of-pocket costs for medications and other treatments, ushering them more quickly into medical debt.

In 2013, PAF case managers obtained $48,215,994 in debt relief funding for patients experiencing medical debt crises, an 84 percent increase from 2012. Medical debt remains a serious issue for PAF patients.  Due to the unpredictable and involuntary nature of medical expenses, most patients are unable to plan for costly medical bills.  Even a smaller bill can affect their credit score, while the larger bills and access issues experienced by PAF patients drive patients nationally into bankruptcy.

For this reason, PAF’s sister organization, NPAF, has made medical debt crisis issues a federal policy priority in 2014.

Distributed with the PDAR at a Capitol Hill briefing today, the NPAF white paper, titled Medical Debt, Medical Bankruptcy and the Impact on Patients, reports that medical expenses contribute to 62 percent of individual bankruptcy filings and affect both insured and uninsured patients. Fourteen percent of people with private insurance struggle to pay medical bills, while more than 25 percent who have public coverage and more than 36 percent who are uninsured grapple with their medical expenses. In 2012 the Commonwealth Fund found that upwards of 41 percent of adults aged 19-64, or 75 million people nationally, reported problems paying medical bills or paying off medical debt over time.

Originally published in 1997, the PDAR has been increasingly requested by lawmakers, MedPAC, congressional offices, academics and advocacy organizations as a quality assessment tool across many different dimensions, including age, ethnicity, employment status and clinical conditions. 

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About Patient Advocate Foundation

PAF is a national nonprofit organization, established in 1996, that seeks to safeguard patients through effective mediation ensuring access to care, maintenance of employment and preservation of financial stability relative to their diagnosis of chronic, life threatening or debilitating disease. Patient Advocate Foundation has been consistently rated as a 4-star “exceptional” charity by Charity Navigator, the foremost independent evaluator of charities in the United States.

PAF data are derived from patients who contacted the organization for assistance in accessing quality care.  These experiences have been quantified in the PAF’s Patient Data Analysis Report, which illustrates the data collected across 260 variables by PAF senior cases managers.  In 2013, PAF resolved 88,364 patient cases and received more than four million additional inquires from patients nationally.  Most requests were from patients needing assistance with accessing healthcare—either because they could not afford the care recommended, could not obtain services within reasonable proximity to where they lived, or were denied coverage for services and treatments within the purview of their health plan.  PAF’s ability to assist patients confronting a wide spectrum of challenges enables NPAF to competently serve as the voice of this vulnerable patient population, many of whom will be accessing health insurance through state or Federally-Facilitated Exchanges for the first time.

The mission of NPAF is to be the voice for patients who have sought care after a diagnosis of a chronic, debilitating or life-threatening illness.  NPAF has a seventeen year history serving as this trusted voice.  NPAF is also the coordinator of the Regulatory Education and Action for Patients (“REAP”) Coalition.  The policy and advocacy activities of NPAF are informed and influenced by the experience of patients who receive direct, sustained case management services from our companion organization, Patient Advocate Foundation (“PAF”). 

 For more information about Patient Advocate Foundation, please visit www.patientadvocate.org or call
toll-free
(800) 532-5274.

To access a copy of the report visit www.patientadvocate.org/pdar