Robert Graham Center Research

Study: High Deductibles Cause Patients to Delay Care

November 22, 2016 03:39 pm Michael Laff Washington, D.C. –

Making health care available and affordable is essential to expanding access to care, but high-deductible insurance plans are causing some patients to delay or forgo care, according to recent research.

[African American doctor with senior male patient sitting on exam table]

In a one-page research brief( titled "High-Deductible Plans May Reduce Ambulatory Care Use," researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care studied the effects of high-deductible health plans on decisions that individuals with chronic conditions make about their care.

What researchers found is that high-deductible plans may be working against better health outcomes for patients who need care the most. As the number of chronic conditions increased for each patient with a high-deductible plan, so did that patient's level of debt and likelihood of delaying or forgoing health care. Just 9 percent of patients with a high-deductible plan and no chronic conditions chose to delay or forgo care, but among those with three or more chronic conditions, 25 percent delayed or went without care.

"Although high deductibles were aimed at reducing unnecessary care, individuals are avoiding or delaying necessary care," Anuradha Jetty, M.P.H., a Graham Center researcher and co-author of the study, told AAFP News. "Once this happens, more people will stop taking necessary medications, leading to a worsening of their conditions that may require hospitalization when their care tends to get more complicated. These are all consequences of having chronic conditions and more sickness, which will increase the overall cost over the long term."

Researchers found that 52 percent of patients with high-deductible plans who had three or more chronic conditions reported carrying medical debt, compared with 28 percent of patients with these plans who had no chronic conditions. Among patients with three or more chronic conditions, 56 percent reported their annual out-of-pocket costs exceeded $2,000.

The Graham Center researchers identified high-deductible plans as those having a deductible of at least $1,200 for an individual or $2,400 for a family. Researchers used data compiled by the National Health Interview Survey through interviews conducted between 2011 and 2013. Respondents ranged in age from 18 to 64 and were enrolled only in commercial insurance plans.

Many patients find insurance plans with low premiums attractive, but such plans typically include high deductibles and high out-of-pocket limits. Although the Patient Protection and Affordable Care Act (ACA) was passed to reduce the burden on patients who need care the most, high-deductible plans may be contributing to poor health outcomes and higher overall cost of care.

Insurance plans sold through state exchanges under the ACA offer a subsidy on premiums for low-income patients, but they do not protect patients from potentially high out-of-pocket costs.

"Exempting preventive care, outpatient services and medications from the deductible and strengthening financial assistance for health insurance coverage will ensure that families receive care that they need," said Jetty.

Making insurance more affordable for all individuals was one of the key messages the AAFP conveyed in a Nov. 9 letter(2 page PDF) to President-elect Donald Trump.

"Ensure that patients do not face financial obstacles to securing primary and preventive care, especially those individuals who have high-deductible health plans," AAFP President John Meigs, M.D., of Centreville, Ala., urged Trump in the letter.

In an upcoming study, Graham Center researchers will examine more detailed demographic data, including race, ethnicity and income level of patients with high-deductible plans and will study how costs influence their health decisions.

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Fresh Perspectives Blog: High Deductibles: Out-of-Pocket Shouldn't Mean Empty Pockets