Late in May, one of Dr. Thomas Albani's patients came to see him after she had detected a lump in her breast.
“She knew she had this for a couple of months, but she didn't do anything about it,” said Albani, a family physician in Youngstown, Ohio.
The patient's husband was already coping with a prostate cancer scare. The looming threat of paying down a high deductible had kept her away from the doctor's office. “Unfortunately, in her situation, she now has a breast cancer that's further along than it should be because she kept putting it off,” Albani said. “And that was all due to her high deductible.”
Since a famous RAND Corp. study came out more than three decades ago, it has been well documented that out-of-pocket expenses influence people's health choices, and not always in a positive direction. High deductibles lead people to cut back on both less effective services and on interventions that matter.
This patient failure to discriminate between high- and low-value services runs counter to another cost-cutting effort—accountable care, which depends on patients receiving timely treatments, having their chronic diseases better managed and having them take advantage of preventive screenings. A growing number of experts fear erecting high deductibles on the path to healthcare could backfire by undermining moves to save money through encouraging high value services.
“The high-deductible health plans are working against what we're trying to do in the accountable care movement, which is to eliminate barriers to access to physicians, particularly primary-care doctors, and to eliminate barriers to prevention and wellness,” said Dr. David Shulkin, president of the Atlantic Accountable Care Organization, a group of hospitals and doctors in New Jersey that coordinates patient care. “This can be potentially harmful to us.”
Reductions in healthcare utilization—and the resulting effect on costs—are the key reason why high-deductible health plans have spread like wildfire across the U.S. The biggest drivers have been employers seeking to slow the growth in premiums by having employees spend down a deductible before their benefits kick in.