High-Deductible Plans May Impede Care

July 9, 2008 -- High-deductible health insurance plans promoted by the Bush administration 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.

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Controlling Health Care Costs

President Bush has promoted 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.

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.

"People were responding to the financial incentives, but it doesn't look like they were making cost-effective decisions," Greene, an assistant professor of health policy at the University of Oregon, tells WebMD.

Greene says consumer-directed plans are supposed to encourage patients to seek out information on managing their symptoms so they can decide when they need to go to the doctor or buy other services.

But one of the studies shows that while patients in lower-deductible consumer-directed plans are more likely to look up health information on the Internet or in plan booklets, patients using high-deductible plans may in fact be less likely to seek out information.