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On high-deductible plans, people spend less

Posted by on January 30, 2012

Families with high-deductible health plans tend to delay or forgo health care because of the cost, according to a new study by a team of Harvard researchers.

The study, by phone and mail, questioned 208 families in high-deductible health plans and 370 in traditional plans. Membership in a high-deductible plan and lower income “were each independently associated with higher probability of delayed/forgone care due to cost,” the researchers found. “For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes ≥400% FPL]. Similar associations were observed for children.” The families were all in Massachusetts, and were chosen because at least one family member had  a chronic condition that would have suggsted regular care.

“Overall, the study found that individuals in high deductible plans did tend to delay care at a greater rate than those in more traditional plans,” Sarah Kliff writes in Wonkbook, in The Washington Post. “But even more interesting was who was delaying the care: In families where the child had a chronic condition, the healthier adult tended to be the one reporting holding off. For those with an unhealthy adult, however, it was the opposite: Care for children got delayed. These effects were even more significant for lower income families … [who] tended to delay care at higher rates.

This is a matter of particular interest because high-deductible plans are the fastest-growing

sector of the insurance industry. As employers and others seek to reduce premiums, the solution has been high-deductible offerings. Lower premiums and higher deductibles are often accompanied by a Health Savings Account or HSA, which entitles the holder to spend money from an HSA for health care, and to keep the money that isn’t spent.

The theory is that putting people more directly in charge of spending that money — as opposed to the more typical employer-sponsored plan with a $20 co-pay for many services — will encourage consumer-like behavior into the marketplace. The questions: Will people delay necessary care? Will they eliminate preventive care? How are people supposed to know what stuff costs?

For now, the Harvard researchers say, we have this conclusion:

“Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care.”

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