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Study: Loosening of Managed Care Hurts the Poor

The retreat from tightly managed care in recent years has left casualties on the insurance battlefield: people with low incomes and chronic illness.

So says a report by the Center for Studying Health System Change titled "Patient Cost Sharing: How Much Is Too Much?"

For many, the study implies that that question has already been answered. In citing another study published in the New York University Law Review titled, "Rethinking the Debates Over Health Care Financing: Evidence From the Bankruptcy Courts," the authors cite this sobering statistic: "Nearly half of all personal bankruptcies are due in part to medical expenses." HSC gauged the financial effect of increased cost sharing under six health plan models using data from the 1997 Medical Expenditure Panel Survey and adjusting for 2003 health care cost and utilization increases.

With no deductible and a $10 copayment, 1 percent of people with incomes between 125 percent and 200 percent of the federal poverty level have out-of-pocket costs exceeding 10 percent of their income, compared with 23 percent of people in the same income range who have a plan with a $2,500 deductible and coinsurance.

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