High deductibles linked to lower Rx fills and cancer screenings

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Another healthcare pricing study has entered the mix, and like its peers, leaves a key measure unanswered: the health impact cost-conscious decisions have on long-term health and its associated medical costs. These researchers, like others, found that patients dialed back their healthcare behavior in some key areas, such as fewer physician visits and prescription fills, only to up their use of emergency room visits.

Published in the June Health Affairs issue, the study by Paul Fronstin, Martin Sepulveda and Christopher Roebuck, examined the impact Consumer-Directed Healthcare Plans had on employees by comparing results among workers whose insurance was replaced by a high-deductible plan, and those of an office where employees were offered a CDHP or a PPO. Consumer-Directed Healthcare Plans are predicated on the idea that consumers will scrutinize what care they really need when they have to cover a greater proportion of their medical costs. The plans took root in the early 2000s. The plans typically have a relatively lower monthly employer and employee contribution, but a higher deductible before the insured experience begins to replicate that of a PPO or HMO visit in terms of out-of-pocket impact. They are also accompanied by something like a Health Savings Account, to which employees contribute on a pre-tax basis, and which employers often put some money into to kick things off. HSA funds can be used towards the deductible.

Researchers note that the idea behind the prudent consumer concept was typically framed by scenarios such as prodding patients to skip emergency room visits for matters a primary physician or other professional could handle. They also note that CDHP plans accounted for just over 14% of the private insurance business in 2012. They followed employees between 2007 and 2010 – a time period that happens to bookend the 2007 recession.

Among the findings were that cancer screenings among CDHP patients fell to a greater degree than among non CDHPers in 2007. The data point is of particular interest because it indicates a possible overhang effect that comes with a CDHP program – these screenings were in fact free for these patients, as they were for patients who were not in these high-deductible groups. Although screenings among high-deductible patients have begun to edge upwards, they have not returned to the baseline rate.

Researchers say that healthier choices are considered a built-in part of the idea of a prudent healthcare consumer, and this screening gap could be a flag that patients are not well-versed in their plans. They also found a surprising uptick in 2007 CDHP patient emergency room visits, a foggy event they cannot explain, and that prescription fills fell among CDHP patients, a change that is “consistent with the expectation CDHPs will tend to dampen demand for some medical services.” Researchers were also unable to determine if falling prescription numbers were for unnecessary prescriptions or for essential ones that could possibly explain the 2007 jump in emergency room services.

The immediate takeaway was that CDHPs need to do more to inform patients about benefits and provide health-forward incentives, but could not offer a long-term cost/benefit analysis of these plans.

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