Almost half of health plans in the US have deductibles of at least $1,000 according to a new study. It’s called “cost shifting” and it’s a big part of the future of American health care.
There are two major reasons why employers are doing this.
First, higher deductible plans are cheaper, since there is less risk to insure. Think of your car insurance – why would you make a claim for a ding on your door when it’s cheaper for you to just pay to have it fixed (or fix it yourself)? The higher the deductible, the lower the premium, even if it means more out-of-pocket cost for you for the small stuff.
Along these same lines is the second reason. If employees spend more of their own money on health care, maybe they’ll be smarter about how they spend it.
It sounds good – but does it work?
Yes. And No.
Studies show that consumers in high-deductible health plans do spend less than those in traditional plans. But, they spent less in some worrisome ways:
Childhood vaccination rates dropped. . .Rates of mammography, cervical cancer screening, and colorectal cancer screening also fell among those with high-deductible health plans relative to those in traditional plans. . . . even though high-deductible plans waive the deductible for such preventative care.
As another study put it: “Deductibles can create powerful yet potentially indiscriminate and blunt incentives for consumers to alter their care-seeking behavior.”
Of course, this is a complicated way of saying higher deductibles work, and are smart choices for employees and their employers. But the research tells us they aren’t enough.
Benefits professionals sometimes call higher deductible plans a kind of “shared responsibility.” But as benefits professionals, we should recognize that employees don’t always see it this way. Every time an employee faces a health care problem they too often wonder if their plan will deliver help – or hassles.
For a plan to offer real “shared responsibility” it has to do more than just split the cost of care. It must offer tools that help the insured and their family when sick, and to help them to stay well. Each person must know that their plan is not just a way to pay for care, but something they can count on in a time of need.
It’s what we do at Best Doctors. Last year, two-thirds of the people who called us were facing important medical decisions and weren’t sure what to do. Sure, they had to pay a deductible, but they wondered – should I have surgery? Is radiation the right thing for me? Do I have the right diagnosis? Their questions transcended the simple question of their deductible.
And so to employers I say this: know that your employees need this help, and offer it to them.