Poisonous Lily

Are High-Deductible Plans a Health Hazard?

In high-deductible health plans, we have a powerful idea that is not what it seems. The idea is pretty simple. Lower the cost of health insurance. Give people higher deductibles for routine care that might not be necessary. Suddenly, people are more sensitive to the cost of unnecessary health care. But the results of a natural experiment, published in JAMA Internal Medicine, suggest it’s not a simple, winning formula.

For people with comfortably high incomes or no chronic health issues, high-deductible plans might not be much of a problem. But for low-income patients with diabetes, the story was very different. Visits to hospital emergency departments increased by more than 20% after switching them to a high-deductible plan. Those visits were for preventable diabetes complications. Clearly, that was not the plan behind these plans. The authors call for better designs:

Vulnerable patients with diabetes switching to high-deductible insurance experienced major increases in acute diabetes complications. They might require protection under improved health insurance designs.

Unfortunately, this story is all too familiar. Health policy comes down from people with the privilege of wealth and good health. The idea of cost sharing sounds great if you can easily write a check for those out-of-pocket expenses. And with a significant buffer between yourself and financial hardship, you can make good decisions about paying for medical care based on real value.

But take away those privileges and the out of pocket costs for any medical care are daunting. Paying the rent is a more basic need.

Privilege comes from health, as well as wealth. Privilege carries an obligation to care for people who lack those privileges, especially when making health policy. We can do better. The headlong rush toward high-deductible health plans is hurting people.

Click here for the study and here for a companion commentary.  Here, you can find more perspective from MedPage Today.

Poisonous Lily, photograph © кiт-кaтн Halкeтт / flickr

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January 10, 2017

2 Responses to “Are High-Deductible Plans a Health Hazard?”

  1. January 10, 2017 at 10:00 am, Allen Browne said:

    Yup! High deductibles lead to less healthcare. Less healthcare is eventually more expensive for our society. We need a broad, longterm look.

  2. January 10, 2017 at 1:20 pm, Jonathan said:

    Such an interesting topic, and thanks to the authors for this analysis to show that HDHPs are not the panacea that advocates think they are.

    I do think when paired with a seeded HSA, HDHPs can be more successful–but we are talking about the employed with benefits population here, which excludes lower income individuals, for which HDHPs are most certainly an inappropriate option due to a likely absence of even moderate savings (in an HSA or otherwise).

    Interestingly, you said, “Privilege comes from health, as well as wealth,” although the converse can also true. . .privilege and wealth, sadly, can be such a strong predictor of health.