New insurance options may lead patients to skip care

Some patients with high-deductible plans forgo needed screenings, a study found. But supporters of such plans cite contradictory data and say coverage still works.

By Kevin B. O'Reilly, AMNews staff. Nov. 14, 2005.

High-deductible health plans combined with health savings accounts are an increasingly popular choice for employers and patients but could hurt long-term outcomes by discouraging necessary care, according to new poll data from market-research firm Harris Interactive.

An online Harris survey including 900 patients enrolled in HDHPs found they were less likely than those with traditional plans to get preventive care such as Pap tests and prostate-specific antigen tests. The surveyed patients were enrolled in plans with a deductible of at least $1,000 for individual coverage and $2,000 for families, though the plans were not necessarily paired with health savings or reimbursement accounts.

Patients with chronic conditions who were enrolled in HDHPs were more than twice as likely as patients insured by a traditional plan to fail to fill a prescription because of cost, according to a Harris phone survey. The study found that 28% of those enrolled in HDHPs planned not to fill a prescription compared with 13% in traditional plans.

"My hope would be that health plans would figure out some kind of strategy so people aren't just cutting out all kinds of care across the board," said Kinga Zapert, PhD, vice president for health policy research at Harris Interactive, New York. "It's difficult for patients to determine on their own which care is needed and which is not."

The data, published in the Sept. 22 New England Journal of Medicine, also show patients are no more aware now than they were in 2001 of publicly available quality ratings of physicians, hospitals and health plans.