Every person’s health needs are unique thanks to factors such as age, genetics, racial and ethnic background, chronic conditions, sex, gender, environment, and socioeconomic circumstances. These factors can affect how patients respond to treatments.
Yet health care and insurance coverage are often designed for the “average” patient, assuming all people have the same needs or the same treatment responses. This can create barriers for some patients in accessing the most effective care for them.
The National Pharmaceutical Council’s updated booklet, “The Myth of Average: Why Individual Patient Differences Matter,” explores how patients, health care providers, insurers, and other decision-makers can better consider individual patient differences when navigating the complexities of health care and insurance.
"The Myth of Average" addresses important questions such as:
- Why do individuals have different responses to the same treatments?
- If a patient is not “average,” how could that impact their access to treatment?
- What tools and evidence do insurers rely on to make coverage decisions?
- What challenges do insurers face when trying to cover patients with different treatment responses?
- How can insurance benefit design change to improve patient access to high-quality health care treatments and services?
Key takeaways from "The Myth of Average":
- Patients differ. Individual patients can respond in different ways to the same treatment due to factors such as age, genetics, chronic conditions, racial and ethnic background, sex, gender, environment, socioeconomic circumstances, and personal treatment preferences. Because of this, the treatment that’s best for most patients may not be the one that’s right for a specific individual.
- Health care decisions are often made at the population level, rather than the individual patient level. Most health insurance plans design their policies to meet needs of the majority of people. Even though differences among patients are common, they are not always considered in treatment and coverage decisions, unintentionally creating barriers to the most effective, appropriate care for some patients.
- Health insurance coverage needs to be more patient-centered and fair. Insurers and other health care payers should adopt policies that align patient cost sharing with clinically appropriate care, such as by providing flexibility in cost sharing for patients and covering high-value treatments and services before patients meet their deductible.
Check out this infographic for highlights from NPC's "The Myth of Average" booklet on the factors that drive individual patient differences and how patients, health care providers, and insurers can better acknowledge these differences within the health care system.