When health plans go high deductible

(Courtesy of Journal of General Internal Medicine)

As health costs rise, employers are increasingly turning to high-deductible health plans: Insurance coverage that usually pairs catastrophic coverage with a health savings account, leaving consumers to decide what to spend that account on. The goal is to give consumers more incentives to not spend on the care they don’t need, but these plans often raise concerns that subscribers will cut back on the care that they do need, too. A new study from a team of Harvard researchers explores how health insurance plans with high deductible effect the care that families do, and don’t, seek.

Researchers focused on families where at least one member has a chronic condition, that would likely require a greater amount of medical care. They compared families in Massachusetts who were enrolled in high deductible plans against those with more traditional insurance coverage.

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. 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, as you can see in the chart above, tended to delay care at higher rates.

“One of the things that was fascinating was we tried to look at interfamilial effects,” says the study’s lead author, Alison Galbraith. “If you have someone who has a chronic condition, who is foregoing care, it looks like the healthy people are cutting back. Those are the people to worry about.”

What this study couldn’t probe was whether the delayed care was essential. If the care was indeed needed, that could be problematic and costly, leading to higher health care costs for any complications that arise down the line. If it wasn’t, it would signal a high deductible health plan working as it should, encouraging individuals not to seek the care they don’t need.

Either way, the impact of high deductible plans is becoming increasingly felt in the health care sector. Enrollment in high-deductible plans, among those with employer sponsored insurance, has more than doubled in the past two years, from 8 percent in 2009 to 17 percent last year.