Cost Sharing – A Closer Look Reveals Unintended Consequences

Recently the NY Times had an article commenting on the unforeseen consequences of cost-sharing among patients with chronic illnesses like diabetes, hypertension, and heart disease. This is based on a recent study from The National Bureau of Economic Research that observed patients with higher cost-sharing for medications tend to cut back on them which can have deleterious consequences – more ER visits, hospitalizations, and complications from their chronic illnesses. This would then lead to more healthcare spending which is what cost-sharing was meant to decrease. Check out the article below and click on the link above to the study!

With Sickest Patients, Cost Sharing Comes At A Price

Case Challenge #16

The History

A 19 yo white male with no past medical history presents with hand tremors, slurred speech, and severe anxiety, all of which have progressed over the last 3 months. Present both at rest and with activity. Also notes a change in personality, characterized as “extremely anxious.” Initiated on anxiety medication without improvement. This has progressed to the point that anxiety has caused him to drop out of school. He comes in now with slurred speech, excess drooling, and difficulty walking. Denies visual changes, HA, Sz. No obvious wt loss. No fevers, chills, night sweats. No unusual travel or exposures.

  • Past medical/surgical history: none
  • Family history: grandfather with liver problem
  • Social history: no tobacco, alcohol, or drugs. Not sexually active. Lives at home. No pets.
  • Current Medications: alprazolam 1.75 mg at bedtime, citalopram 20mg daily

The Physical

  • Vital Signs: T 37.1, P 80, BP 140/75, RR 16, O2 sat 98% RA
  • Neurologic exam:
    • Awake and oriented x3
    • Tongue protruding; speech is slightly dysarthric; cranial nerves otherwise intact
    • Strength 5/5 in all extremities; tone increased in bilateral lower extremities
    • Fine hand tremor, increases with movement
    • Sensation intact
    • Deep tendon reflexes 2+ throughout
    • Romberg negative
    • Gait is wide-based, and spastic
  • Initial ocular exam not conducted
  • Remainder of exam is normal

The Labs

  • WBC 4, Hgb 14, Hct 40, plt 79 || BMP unremarkable, glucose 88
  • Albumin 2.5, INR 1.4
  • TSH normal

The Imaging

  • US abdomen: Nodular hepatic surface contour suggestive of cirrhosis

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