High-deductible Plans and Emergency Care Use.

High-deductible insurance plans continue to spread, subjecting an increasing share of the population to relatively expensive payments for some care.  The notion is that people will become better consumers, but some may avoid needed care.  One category of care almost always subject to the deductible, and often to additional copayments or coinsurance, is emergency care.  A Health Affairs article describes the apparent impact of high-deductible plans on emergency room use, with a focus on high-severity conditions, those which likely really required immediate intervention.   (HA Article)   The study used only one Massachusetts health plan and looked at emergency care use before and after introduction of a high-deductible plan, but it should be noted that the plan at issue was not linked with a health savings account.  The study used a variety of adjustments, including socioeconomic status.  Among higher socioeconomic status members, those in a high-deductible plan compared to a control group showed a reduction in low-severity emergency care use but no reduction in higher-level emergency care.  For the lowest socio-economic group, however, while lower acuity emergency visits did not decline, higher severity ones did, as did hospitalizations, at least initially, but with a rebound in subsequent years.  This limited data set suggests that this lower socioeconomic group was not making the best decisions about avoiding care in the interest of saving money.  For health plan designers and operators this indicates a need for outreach and education to help these persons make good decisions for their health, and also for overall long-run health spending.