Risky business: consumers and CDHPs
People enrolled in high-deductible health plans tend to make more risky health decisions than those enrolled in lower-deductible plans, according to a study published in the July/August issue of Health Affairs.
In Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior? the authors find the answer is, "yes," probably.
Enrollees in the high-deductible CDHP were more likely to forgo medical care to save money.
The study distinguishes between potentially risk health behavior like forgoing a visit to the doctor when ill, versus cost-saving behavior such as choosing to have a less-costly diagnostic test.
In the risky category, behaviors included not going to a doctor when people thought they should have, taking a lower dose of a prescription drug than was recommended, and deciding against undergoing a lab test.
In the risky category, behaviors included not going to a doctor when people thought they should have, taking a lower dose of a prescription drug than was recommended, and deciding against undergoing a lab test.
A note about the methodology: data were drawn from a large single-employer population consisting of employees enrolled in high- or lower-deductible CDHPs at the beginning of 2004. Study participants had relatively higher incomes and education attainment, and the sample was not as ethnically diverse as the general US population.
Health Populi's Hot Points: While there may be some mixed results in this study, there are some important policy implications. A large proportion of health care consumers appear to be forgoing medical care in the midst of growing financial risk. Americans face stagnant incomes and lower disposable household income when confronted with escalating gas and food prices, and declining 401(k) returns. This is true for most Americans whether or not they are enrolled in higher-deductible health plans like CDHPs. The unintended consequences of forgoing health care could wreak havoc on health costs -- in treating people later in disease processes -- and increasing visits to ERs in the coming months. Public policy and employer plan designs should be realistic about this scenario, which is going to be more real for more people through 2008 and beyond.
posted by Jane Sarasohn-Kahn at
8:29 AM
2 Comments:
I've researched the subject of consumer behavior in CDHPs and HDHPs as I wrote my book on the topic entitled "Consumer Directed Health Care--A 360 Degree View" and can say that the Health Affairs piece is generally in line with all the reputable sources that have also examined the question.
If we want consumers to engage in the oversight of their health care, we have to recognize that the design of current CDHPs is flawed. As was suggested in the 7/11/08 edition of the Wall Street Journal, these out of pocket obligations should be tied to income and capped. I've proposed the limit at 5% of household income. This approach will require a great deal of work, but the results will be worth the effort.
However, we also have to change physician incentives, since medical professionals influence so much of what gets recommended and eventually done for patients. The average consumer has a high school eduction, reads at about the 6th grade level, and stands a one-in-three chance of being "health illiterate." Unless the care delivery system is there to support these individuals by making it easy for them to do the right thing (and hard to go astray) we have little chance of engaging consumers in health care.
By
Kim D. Slocum, At
July 11, 2008 2:35 PM
Thanks for your comment, Kim. Your recommendations on incentives for physicians, out-of-pocket limits for consumers, and 'nudging' people to do the right-health-care-thing are all spot-on! JSK
By
Jane Sarasohn-Kahn, At
July 11, 2008 6:58 PM
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