High-deductible health plans continue to grow rapidly, particularly since the advent of the most recent recession. They are controversial because of concerns that they may cause patients to skip needed care. A survey reported in the Journal of General Internal Medicine attempted to evaluate levels of deferred care due to cost in high deductible plans versus traditional ones. The high-deductibles ranged from $1000 to $6000 per family and covered almost all services, but not office visits or preventive care. Some of the enrollees had health saving accounts attached to the plan. The traditional plans did not have a deductible. About 208 families in high-deductible plans and 370 in traditional ones were surveyed. High-deductible families did not defer care for children more than those in traditional plans, except for ER visits. While in general more care deferral due to cost was reported in high-deductible plans, this did not apply to people in the family who had chronic conditions. Lower income families were more likely to report care deferral. (JGIM Article)
We have been skeptical, indeed cynical, about the “consumer-directed” high-deductible health plan, largely because we believe the motivation is almost solely to shift costs from the employer to employees and because we think a large subset of consumers have difficulty making informed decisions about their health and health care, although it is undoubtedly true that having a financial incentive may help even these consumers focus and do a better job of gathering information and making rational choices. But although the authors clearly were trying with this survey to paint a picture of the evils of high-deductible plans, this research is a very weak instrument for that purpose. The sample size is small, self-reported survey information is not very reliable and most importantly, the researchers included absolutely no data on actual health outcomes. The fact that patients with chronic conditions did not defer care more with a high-deductible plan suggests there probably wasn’t a significant negative effect on such outcomes. If the health outcomes aren’t negative, and costs are probably lower, it is hard to see a problem with the plans.