Mary Reed, Vicki Fung, Mary Price et al.
M. Reed, V. Fung, M. Price et al., "High-Deductible Health Insurance Plans: Efforts to Sharpen a Blunt Instrument," Health Affairs, July/Aug. 2009 28(4):1145–53.
Access to the full article is available at: http://content.healthaffairs.org/cgi/content/abstract/28/4/1145
Enrollment in high-deductible health insurance plans and other plans with substantial cost-sharing has been growing. While seeking to encourage consumers to use care more judiciously, these plans can have unintended clinical and economic consequences, particularly if consumers do not have the knowledge or tools to make prudent decisions in seeking health care. This study sought to learn how well consumers understand the often complex benefit structure of their plan and how their care-seeking behavior is affected by cost-sharing.
Health insurance deductibles can create "powerful yet potentially indiscriminate and blunt incentives for consumers to alter their care-seeking behavior," the authors say. To align cost-sharing incentives with treatment goals, consumers require more informational and decision support, according to the authors, to understand their plan’s benefits and "differentiate when care is necessary, discretionary, or unnecessary."
A stratified random sample of members of Kaiser Permanente California, a prepaid integrated delivery system, was interviewed by telephone beginning in January 2006. Interviewers ascertained members’ knowledge of various cost-sharing structures, including whether they had a deductible and which services applied to the deductible, as well as how out-of-pocket spending affected decisions to seek emergency department visits, medical tests, and office visits. Responses from enrollees in various deductible plans were compared with those from members enrolled in plans without deductibles.
Complex benefit design and poor understanding of plan benefits can lessen the intended effects of cost-sharing in reducing enrollees' unnecessary use of services, as well as limit protection against unintended effects of exempting preventive care and other selected services.