High-Deductible Plans May Impede Care

Studies Show Patients Skip Doctor Visits and Medications

From the WebMD Archives

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."

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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.


Advocates see that as a key way to control health costs: Consumers spending their own money are less likely to get wasteful care or unnecessary tests that drive up costs.

But critics warn that without adequate information educating consumers on what separates appropriate care from wasteful spending, patients are likely to skip treatments they need in order to save money.

And these studies show that scenario is exactly, in many cases, what is happening, says Jessica Greene, PhD, a co-author of both reports.

"People were responding to the financial incentives, but it doesn't look like they were making cost-effective decisions," Greene, an assistant professor of health policy at the University of Oregon, tells WebMD.

Greene says consumer-directed plans are supposed to encourage patients to seek out information on managing their symptoms so they can decide when they need to go to the doctor or buy other services.

But one of the studies shows that while patients in lower-deductible consumer-directed plans are more likely to look up health information on the Internet or in plan booklets, patients using high-deductible plans may in fact be less likely to seek out information.

"The information piece was supposed to make the difference, and to date the information piece is not changing people's responses," she says.

The researchers urge newer plans to exempt preventive care and medications for chronic diseases from plan deductibles. That would help prevent patients from shying away from care as a way to cut costs.

Greene also says moves by some newer plans to educate policy holders about health information when they sign up for coverage "shows promise." That's instead of patients waiting until they're "in crisis" with their health to scramble for information, she says.

Balancing Care with Waste

Advocates see that as a key way to control health costs: Consumers spending their own money are less likely to get wasteful care or unnecessary tests that drive up costs. And as consumers get more savvy, the idea is that the health care industry will become more competitive, also lowering costs. The lower premiums can also give more people the opportunity to get some coverage even if they can’t afford full-premium insurance.


WebMD Health News Reviewed by Louise Chang, MD on July 09, 2008



Greene, J. Health Affairs, July/August 2008; vol 27: pp 1111-1119.

Dixon, A. Health Affairs, July/August 2008; vol 27: pp 1120-1131.

Jessica Greene, PhD, assistant professor, University of Oregon.

Robert Zirkelbach, spokesman, America's Health Insurance Plans.

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