High-Deductible Plans May Impede Care

July 9, 2008 — High-deductible health insurance plans promoted as a key way
to control medical spending appear to lead policy holders to avoid health care
they need, a pair of studies released Tuesday concludes.
The studies show that patients using high-deductible “consumer-directed
health plans,” or CDHPs, are more likely to skip recommended doctor’s
visits and take less than the recommended dose of heart medications.
As many as 12 million Americans are now using high-deductible insurance
plans along with health savings accounts, according to industry data.
Authors of the studies say health plans should do more to educate patients
using the plans about how to get lower-priced drugs and treatments rather than
cutting back on care.
In one study, patients using the high-deductible plans in 2004 were 3.5
times more likely than patients using a traditional preferred-provider
organization (PPO) to report that they’d avoided going to the doctor when they
thought they should. The figure dropped to twice as likely in 2005.
At the same time, another study found it two to three times more likely that
patients in the high-deductible plans failed to fill prescriptions for blood
pressure or cholesterol-lowering medication.
“Patients’ self-reported behavior in this study suggests that they may
be forgoing or delaying recommended care,” concludes one of the studies,
both of which were published in the policy journal Health Affairs.
Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the
industry’s main lobbying group, says consumer-directed plans are still
“relatively new” and that the relationship between patients and the
plans is still in flux.
“Consumers are getting more used to the concept of consumer-directed
care,” he says. “It’s hard to tell what this [study] says about the
trend in general.”

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Controlling Health Care Costs
Backers promote the use of high-deductible insurance plans along with health
savings accounts as a way to spread insurance to more consumers. Patients can
buy the plans for lower premiums, but they also require consumers to spend more
of their own money on their care than they would in a traditional
employer-sponsored insurance plan. Health savings accounts, often paired with
consumer-directed plans, let consumers save money tax-free to pay the
premiums.
Advocates see that as a key way to control health costs: Consumers spending
their own money are less likely to get wasteful care or unnecessary tests that
drive up costs.
But critics warn that without adequate information educating consumers on
what separates appropriate care from wasteful spending, patients are likely to
skip treatments they need in order to save money.
And these studies show that scenario is exactly, in many cases, what is
happening, says Jessica Greene, PhD, a co-author of both reports.