CDHPs and Health Use

Although it is not discussed as often as cost and quality issues, access to care is a third important aspect of the health system.  While most people have literal geographic access to various health care resources, insurance or money to pay for that care is usually treated as a more significant access issue, along with enough intelligence or knowledge to know how to use health care resources.  It is not that the affected individuals don’t have access to care, it is more that they chose not to use it because of cost concerns.  The growth of consumer cost-sharing, primarily in the form of high deductibles and copayments has sparked concern about effects on access to or use of resources.  In a report based on its surveys of consumers, the Employee Benefits Research Institute finds that there is a relationship between income, coverage and use of services.   (EBRI Report)   The researchers found that 26% of people with traditional coverage reported a delay or avoidance in care due to cost concerns, compared to 40% of people with high-deductible plans with no savings account, and 30% of those in a high-deductible plan with a savings account.  Having a medical home did not appear to affect access issues in general.  As expected, people with lower incomes reported more access issues regardless of plan type, with limited exceptions.  The most significant factor appeared to be length of time with a plan with a savings account feature.  The longer people were in this kind of plan the fewer access issues they report.  This is likely explained by a learning process of understanding exactly how the accounts can be used and that they will cover deductible and copayment expenses.