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America's sickest have big health costs, can afford to pay the least

Senior woman sick
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These very sick folks aren't getting what they pay for.

New studies find that the 12 million sickest Americans tend to be the ones who are least able afford their medical expenses. That's despite the fact that nearly all of them have some form of health insurance.

The Commonwealth Fund studies also found that even though these Americans spend more money than other adults on health services, they're "much more likely to report having an unmet medical need." They're also less likely to report having good communication with their provider, the studies found.

"The sickest patients have the highest medical spending but cannot reliably get the health care they need, even though they have insurance," said Dr. David Blumenthal, president of The Commonwealth Fund. "This is a sign that our health-care system is failing its most vulnerable patients."

The health-care research group's reports, released jointly Monday, look at the demographics, medical spending and experiences of adults who have at least three chronic illnesses, while at the same time dealing with a functional limitation that makes it difficult for them to perform the simplest daily tasks, like making a phone call.

More than half of those 12 million people are over the age of 65.

As a group, they tend to be less educated and have lower incomes than American adults overall. They're more likely be female, white and insured by government-run health programs, such as Medicare and Medicaid, according to one of the reports.

About 96 percent of the group has some form of health coverage, including private insurance.

Because of their number of illnesses and physical limitations, the 12 million sickest people have much higher health expenses than other kinds of sick adults, as well as the overall population.

The average annual health spending per person for the sickest adults is $21,021. That's almost three times the $7,526 per capita annual spending of adults with at least three chronic illnesses but no functional limitations, one of the reports noted. And it's more than four times what is spent on average for adults, $4,845.

The amount of annual out-of-pocket expenses for medical services — the share not covered by insurance and personally owed by a patient — was an average $1,669 for the sickest adults, according to the Commonwealth Fund. That's more than twice the average annual out-of-pocket expenses for all adults, who spend $702.

Yet the median household income of the sickest adults is less than half that of the overall population.

"We are asking the sickest people to pay the most, when they have the lowest incomes," said Gerard Anderson, a co-author of the studies and a professor at Johns Hopkins Bloomberg School of Public Health.

At the same time, "this much higher level of spending care does not appear to buy consistently better access and care experiences," one of the studies noted.

A total of 20 percent of the sickest patients reported having an unmet medical need, defined as either not getting or delaying necessary medical care or medications. That compares with just 12 percent of adults who have at least three chronic illnesses but no functional limitation, and 8 percent of the total adult population.

Unmet medical need was highest among the sickest Americans with private health insurance, according to one of the studies.