Q. Why is addressing health care affordability such a pressing public health issue?

A. Affordability is a widespread problem even as fewer Americans go without health insurance. The amount people spend directly on health care (not including insurance premiums), known as “out-of-pocket” costs, has been growing faster than inflation and this has several important implications. Surveys consistently show that people delay or forgo care due to cost, worry about their ability to pay for health care bills, and incur medical debt.

Health care affordability—or a lack thereof—can harm individual health. Affordability impacts whether people can get the care they need, like insulin to manage their diabetes or following up on a mammogram. If those are too costly, people will delay or skip care, which has significant impacts down the line on both health outcomes and cost.

As health care expenses continue to go up, household budgets have to adjust—which means people can’t afford the same kind of groceries or housing they’re used to. That is a public health problem, which has particularly burdensome effects on lower-income, high-need families.

Finally, rising costs create an increased risk that people will face catastrophic health care situations that have massive financial implications, with consequences ranging from mortgaging their homes to personal bankruptcy. That also has a direct consequence on people’s well-being.

Q. What are the biggest challenges facing the next administration on addressing health care affordability?

A. The biggest challenge is simple: The forces that make health care increasingly unaffordable are complicated.

The biggest threat we’ve found is consolidation in medicine. For example, there is a growing trend of hospitals and other corporate entities buying up physician practices and then negotiating as a unit with health insurance companies, driving up prices significantly.

In order to begin addressing health care affordability and its root causes, we have to recognize where medical monopolies are forming and try to prevent them from passing on inflated prices to consumers.

Read the full article about health care affordability by Jeff Sobotko at Harvard T.H. Chan School of Public Health.