People with high-deductible plans make riskier decisions

HealthaffairsPeople enrolled in high-deductible health plans tend to make more risky health
decisions than those enrolled in lower-deductible plans, according to a study published in the July/August issue of Health Affairs.

In Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior? the authors find the answer is, "yes," probably.

Enrollees in the high-deductible CDHP were more likely to forgo medical care to save money.

The study distinguishes between potentially risk health behavior like forgoing a visit to the doctor when ill, versus cost-saving behavior such as choosing to have a less-costly diagnostic test.

In the risky category, behaviors included not going to a doctor when people thought they should have, taking a lower dose of a prescription drug than was recommended, and deciding against undergoing a lab test.

A note about the methodology: data were drawn from a large single-employer population consisting of employees enrolled in high- or lower-deductible CDHPs at the beginning of 2004. Study participants had relatively higher incomes and education attainment, and the sample was not as ethnically diverse as the general US population.

Jane’s Hot Points: While there may be some mixed results in this study, there are some important policy implications. A large proportion of health care consumers appear to be forgoing medical care in the midst of growing financial risk. Americans face stagnant incomes and lower disposable household income when confronted with escalating gas and food prices, and declining 401(k) returns. This is true for most Americans whether or not they are enrolled in higher-deductible health plans like CDHPs. The unintended consequences of forgoing health care could wreak havoc on health costs — in treating people later in disease processes — and increasing visits to ERs in the coming months. Public policy and employer plan designs should be realistic about this scenario, which is going to be more real for more people through 2008 and beyond.

5 replies »

  1. The attempt to migrate us into high deductible health plans as a means to create consumer “buy-in” as a stakeholder in one’s health status is appealing rhetorically, but a dismal failure from a health policy point of view.
    How many more of us need to populate the uninsured and daily growing legions of under-insured as over-paid benefit plan “experts” find increasingly creative ways to slice and dice health benefit plans, cap or otherwise impose additional bureaucratic obstacles to needed care or fair and timely payment for same?
    Bad policy, wrong medicine, wrong time, IMO. The idealistic and laudable “super-med” vision of Paul Ellwood is long gone and now completely compromised by poorly configured, “me-too” attempts of national health plans to emulate authentic integrated delivery systems.
    It is their repeated and overt failures that have opened the door to the so-called misguided “consumer directed health care” movement. Had national carriers (Aetna, United, CIGNA, etc..) studied and understood the essential group cultural infrastructure that was required to seed an “integrated delivery system” that worked, e.g., Kaiser, Cleveland Clinic, Dean to mention a few, we might not have found ourselves in this mess.
    I believe we can trace the genesis of this strategic misfire back to the mid 80s when the Wassermans’ migrated the HMO model (i.,e., Maxicare’s “Window” Project) from niche to mainstream medicine and accelerated the IPA movement as the network platform for all the “me too” players to follow.
    Culture is king and the failure to appreciate it’s role in managed care, the miscalculation of the century.

  2. The above “Peter” is not (the usual) this Peter. “Peter” I suggest we work out a non-confusing name for each of us.

  3. If we look only at health care, then naturally more spending and utilization is good while forgoing care is bad. But ultimately there is a trade off between health care and other goods and services.
    Patients who are enrolled in CDHPs are not JUST forgoing care, they are also saving money to use on other things. So, to make a considered and honest judgment, we should also look at how these people are spending their saved money and whether they are happy with their decisions.

  4. I would be interested in seeing the data behind Peter’s assertions that “There are far more people abusing healthcare resources because they can… than people abusing themselves by neglecting to see a physician when needed.” Is he saying these rates are higher in the general population because there are still far more people in low deductible plans than high, or is he saying this is really true per individual in each respective type of insurance?
    When those in favor of higher deductible plans assert that these are cheaper for insurance company and policy-holder, I ask whether they are also cheaper across life-time costs, per capita, for the taxholder who pays for insurance of last resort for everyone in the u.S. once they get old or sick enough, thereby taking on the high-cost, long-term costs of the failures of short-term lower cost private insurance plans.

  5. While considered a “risky” behavior by some, price conscientiousness is necessary for bringing down long-term healthcare costs due to waste. There are far more people abusing healthcare resources “because they can” with low-deductible plans than people abusing themselves by neglecting to see a physician when needed. Another way to look at it is considering no-deductible plans, where individuals can use however much healthcare resources they want at whatever time they want. Can you imagine if all healthcare plans were like this, the amount of healthcare waste that would happen?
    The higher the deductible, the better. This is because higher deductible plans are substantially cheaper for the insurance company and for the policy-holder, which allows more money left over each month which can be used for visits to the physician’s office. I don’t think that individuals shouldn’t see their physician when necessary, I just think that there should be financial relevance in doing so. Low-deductible insurance plans typically blur any such relevance.