"I was very worried when I heard patients describing credit cards as their last resort to cover medical expenses," he said. "The potential for a destructive cycle of high-interest debt and more financial distress is scary."
Several people in the study were involved in legal matters resulting from unpaid medical debt.
Experts say the Affordable Care Act, the Obama administration's sweeping health reform law, will help. The law closes Medicare's doughnut hole by 2020 and provides certain preventive services at no out-of-pocket cost.
Long term, though, many of the proposals being considered for reforming Medicare "would merely shift costs onto beneficiaries themselves," Lipschutz noted.
The study also found that people "infrequently discussed costs with their physicians," deciding for themselves which treatments were too costly to pursue.
Physicians don't have the time or training to talk to patients about these issues, explained Health Leads' Di Troia. "We've had physicians explain to us they practice essentially a 'don't ask, don't tell' policy around basic resources," she said.
Grande and colleagues mention Health Leads as a model for connecting physician practices with support services that patients need.
"You don't want people skipping or delaying care," said Dr. Jeffrey Cain, a Denver-based family physician and president of the American Academy of Family Physicians. Having a conversation during the visit is important, but that discussion could be led by a member of a patient-care team, such as a nurse or social worker, he explained.
The AARP Public Policy Institute has examined Medicare beneficiaries' out-of-pocket spending.
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