The Downside of High-Deductible Health Plans

What's the tipping point when it comes to making smart choices about whether a visit to the doctor or emergency department is needed? We know that one factor (among many) driving up health care costs is inappropriate use of medical care: getting an MRI for a common headache, or going to the emergency department for a cough or a scrape. If patients had to pay for health care services out of pocket--rather than their insurance companies footing the bulk of the bill--might they think twice about how much health care they're using?

That's one argument for high-deductible health plans--those that have lower monthly premiums but that don't pay for services until a patient has paid a large amount out-of-pocket. The logic is that these plans, with an average annual deductible of around $2,000 for individuals and $4,000 for family coverage (although there is considerable range in these options), force consumers to have "skin in the game" and make smarter choices about health care. But, on the flip side, might people also delay or forego care when they really need it if they know they're on the hook for a huge deductible?






So how do we address these disparities and ensure that people are making good choices about purchasing and using high-deductible health plans? It starts with education and information.

First, people need to understand the terms of their health care plans and consider a whole range of factors--not just the cost of premiums--when choosing health insurance. Too often, I hear people ask, "Well, shouldn't I just go for the cheapest plan?" For some people, that will be the right choice, but for others, it will be a real gamble--in terms of both health and finances--to purchase a plan that has lower upfront costs but high deductibles and co-pays when care is actually needed.

Second, it's critically important that patients enrolled in high-deductible plans are educated about appropriate use of health care services. Part of this is talking with their doctors about whether tests or procedures are necessary, or whether less expensive alternatives are available (the Choosing Wisely campaign has some great resources for patients and physicians on this topic). But the bigger concern is those at the opposite end of the spectrum, those who forego needed care for serious problems and put their health and their lives at risk.

Finally, at the policy level, it seems that more could be done to ensure that the most vulnerable patients have access to truly affordable health care coverage. The subsidies that will be available through Obamacare will provide some relief beginning in 2014, but plans might consider restructuring the deductible rate to encourage lower-income enrollees to seek appropriate care for serious conditions.

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