RWJF: Physicians must help patients navigate high-deductible plans

A study published in this week's Archives of Internal Medicine adds validity to the claim that high-deductible health plans (HDHP) lead individuals to forgo needed care, particularly among lower-income insureds.

By compiling completed surveys of 434 enrollees in HDHPs run by Harvard Pilgrim Health Care, researchers at the Robert Wood Johnson Foundation found that nearly 60 percent of those in the low-income group (with incomes less than 300 percent of the federal poverty level) said they delayed or went without needed care in the previous six months due to cost considerations. Although there was a clear difference in results by income, a substantial 42.5 percent of those above the low-income cutoff also reported forgoing care in the past half-year because of costs.

To researchers' surprise, there were no differences in plan understanding, unexpected costs or information-seeking by income. However, respondents from lower-income families were more likely than those from higher income families to talk with their physicians and to explore alternative options if a hypothetical $100 blood test or a $1,000 screening colonoscopy were recommended.

Lead author Jeffrey Kullgren, MD, MPH, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania, and colleagues said the findings suggested that doctors "have a central role to play in helping their patients navigate the challenges of decision-making in HDHPs," particularly for lower-income families who are more likely to delay or skip recommended care.

While study authors acknowledged the challenges for time-crunched doctors to help patients safely factor cost into care decisions, NPR's Shots blog pointed out that roughly 50 percent of patients in the individual health insurance market currently have plans that are considered HDHPs.

And if Massachusetts health reform is any indicator, more families nationwide will choose to enroll in HDHPs when insurance mandates under the Affordable Care Act go into effect in 2014. Thus, the authors also recommended that "policymakers should consider strategies to support patients facing high levels of cost sharing."

To learn more:
- read the article in MedPage Today
- see the post in NPR's Shots blog
- check out the study in the Archives of Internal Medicine