Those on High-Deductible Health Plans Often Do Without Medical Care
Americans with health insurance that includes high deductibles are more likely to forgo health care than when their health plans have a smaller or no deductible, a new study shows.
Economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel, and Jonathan Kolstad studied a large company that forced more than 75,000 workers and their dependents from a plan with no deductible to one with a $3,750 deductible. The company also gave employees a $3,750 subsidy through a health savings account to help with healthcare costs they incurred.
The result? Not better shopping, but fewer doctor’s visits.
Average per-patient spending fell 15% from $5,222.60 in 2012 to $4,446.08 in 2013, according to Vox. Other declines were noticeable as well, such as a 25% drop in emergency room spending, an 18% decline in physician office visits, and a 6% decrease in mental health services.
Switching to a high deductible was intended to make people smarter shoppers for their healthcare. “Instead, both healthy and sick patients simply used way less health care,” Sarah Kliff wrote at Vox. “This raises a scary possibility: Perhaps higher deductibles don't lead to smarter shoppers but rather, in the long run, sicker patients,” she added.
“I am a little bit surprised at just how poorly patients were able to do when looking at very similar products, like MRI scans, and with a shopping tool,” Kolstad, an economist at the University of California, said. “Two years in, and there’s still no evidence they’re price shopping.”
The study also found that it was the sickest of those insured who were least likely to go to the doctor, even when it was clear they would soon exceed their deductibles. “People who are the most likely to go past the deductible also cut back by the most, and they did that entirely under the deductible,” Kolstad said. “They respond to the spot pricing [the price of receiving care right then], and that leads to a very large reduction in care. We don’t find any evidence they look for a lower cost. They just don’t go.”
-Noel Brinkerhoff, Steve Straehley
To Learn More:
This Study is Forcing Economists to Rethink High-Deductible Health Insurance (by Sarah Kliff, Vox)
Study: High-Deductible Plans Could Deter Sick from Seeking Care (California Healthline)
What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics (by Zarek C. Brot-Goldberg, Amitabh Chandra, Benjamin R. Handel, and Jonathan T. Kolstad, National Bureau of Economist Research) (abstract)
Health Insurance Deductibles Double in less than a Decade (by Noel Brinkerhoff, AllGov)
Healthcare Skin in the Game: Our Skin, Their Game, the Case against High-Deductible Plans (by Steve Straehley, AllGov)
Many Americans with Private Health Insurance Skip Necessary Treatments Due to High Deductibles (by Steve Straehley, AllGov)
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