When high deductibles rule

High deductibles have grown more commonplace in recent years, adopted by employers seeking to shift healthcare costs to households and promoted by policymakers as a way to make patients more cost-conscious.

The shift, however, has also left households vulnerable to medical debt and hospitals with more write-offs from privately insured patients who do not pay.

Now, researchers have used five years of insurance claim and survey data from 59 large U.S. employers to draft projections for health spending among non-elderly adults should the growth in consumer-directed plans continue. Consumer-directed plans include a minimum $1,000 deductible and a vehicle for consumers to save money for healthcare costs.

Spending will drop, but so might use of certain preventive services, the researchers wrote in the health policy journal Health Affairs.

Health spending among non-elderly adults would drop by 1% to 2% if consumer-directed plans accounted for one-quarter the employer-sponsored insurance market. With half the market, health spending among non-elderly adults would fall by 3% to 5%, or $41.1 billion to $73.6 billion. Should three-quarters of the market be dominated by consumer-directed plans, that percentage would increase to 5% to 9%.

(Last year, 17% of employees with health benefits through work were covered by plans with high deductibles and paired with a savings option, said the Kaiser Family Foundation and Health Research and Educational Trust report.)

However, the authors also found lower health spending, by category of service, among consumer-directed plans compared with other health benefit options. That included preventive services.

“The use of all six of the preventive treatments examined in this article was negatively affected in the first year of the consumer-directed plan enrollment, despite plan provisions that reimbursed some of these preventive services at 100% of allowed charges,” the authors said.

Spending for preventive cervical cancer and colorectal cancer services was 4.7% and 2.8% lower, respectively, among consumer-directed patients than those in more traditional plans. The figures controlled for the fact that healthier patients may enroll in high-deductible health plans, the authors said.

Here's one more positive note: patients enrolled in consumer-directed health plans were less likely to fill prescriptions with a brand name drug.

Follow Melanie Evans on Twitter @MHMEvans.

You can follow Melanie Evans on Twitter: @MHmevans.