Consumer-directed plans see drop in primary care

Visits to the doctor and pharmacy dropped among workers whose employer switched their health insurance to a high-deductible plan with a health savings account, a newly released Health Affairs study found.

The results supported concerns raised by previous studies, including a 2011 study by the RAND Corp., that members of consumer-directed plans reduce their use of both medically appropriate and inappropriate services because of the prospect of increased out-of-pocket costs.

The results, published in Health Affairs, compared medical and prescription bills for two Midwestern employers between 2006 and 2010. One of the companies converted its workforce to a high-deductible plan with a health savings option in January 2007. The other company did not.

Routine screening for cancer fell during the year after the insurance switch, despite a benefit design that waived the cost to households for such preventive care. Screening for breast, cervical and colorectal cancer later rebounded. But the initial drop suggests that confusion may prompt people to forgo valuable services, according to the paper.

Meanwhile, emergency room visits edged upward during the third year. Authors Paul Fronstin, a senior researcher associated with the Employee Benefit Research Institute; Martín Sepúlveda, vice president of health industries research with IBM Corp.; and M. Christopher Roebuck, a health policy and economics consultant, called the rise in emergency care unexpected and said results could be a consequence of less primary care.

“Fewer physician office visits may lead to the writing of fewer prescriptions, which could in turn mean that individuals with chronic conditions are less adherent to recommended medication therapy,” the paper said.

Hospital use remained the same, the study found. But the decline in primary care suggests that health plans must “design plans to incentivize primary care and prevention and educate members about what the plan covers,” the paper said.

Supporters of consumer-directed plans say benefit designs typically waive patient cost-sharing for recommended preventive services, and plans are improving how they provide information to members to help them make good choices in the use of services.

Follow Melanie Evans on Twitter: @MHmevans