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High-Deductible Plans May Impede Care

Studies Show Patients Skip Doctor Visits and Medications
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WebMD Health News
Reviewed by Louise Chang, MD

July 9, 2008 -- High-deductible health insurance plans promoted 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.

Robert Zirkelbach, a spokesman for America's Health Insurance Plans, the industry's main lobbying group, says consumer-directed plans are still "relatively new" and that the relationship between patients and the plans is still in flux.

"Consumers are getting more used to the concept of consumer-directed care," he says. "It's hard to tell what this [study] says about the trend in general."

(How have these health plans affected your health? Share your experiences on WebMD's General Health board.)

Controlling Health Care Costs

Backers promote 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. Health savings accounts, often paired with consumer-directed plans, let consumers save money tax-free to pay the premiums.

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