HDHPs Pose No Additional Risk to Medically Vulnerable

The medically vulnerable who enroll in high-deductible health plans are at no more risk for cutting back on needed healthcare than other people who enroll in HDHPs, according to a RAND Corporation study.

The findings are important because more low income and chronically ill people are likely to enroll in HDHPs over the next decade, the study says. Beginning in 2014, as mandated by the Affordable Care Act, Health Savings Account-based plans will be offered in health insurance exchanges to manage the individual and small group markets.

The lower premium plans may be attractive to the uninsured, and the concern has been that despite the lower premiums, high deductibles will make low-income families and the chronically ill more likely to skip needed medical treatments.

Amelia Haviland, lead author of the study and a statistician at RAND, a nonprofit research organization, explained in an interview that that is not the case. "We did not find greater cutbacks for medically vulnerable families. The evidence suggests that non-vulnerable families, low-income families, and high-risk families are equally affected under high-deductible plans."

The study examined the impact of HDHPs on families living in low-income areas where median income is below 200% of the federal poverty level or $44,700 for a family of four. Also examined were families with a member who had one of the five most costly chronic physical illnesses -? cancer, diabetes, heart disease, high blood pressure or kidney disease.

Researchers looked at data from 2003-2007, including medical claims information, for more than 360,000 families enrolled in HDHPs through 59 employers with at least 100 employees each. About 73% of the employers offered an HDHP as a health insurance option during the study. The study group used a traditional health plan in the first year and an HDHP in the second.

The study found that some of the chronically ill enrolled in HDHPs were more likely to receive certain types of preventive healthcare than low-income or non-vulnerable enrollees. The chronically ill were more likely, for example, to undergo all three recommended cancer screenings (cervical, colorectal and mammogram) but diabetics had lower rates of standard recommended tests such as HbA1c, lipid profile and microalbumin.

The study examined whether the size of the deductible affected inpatient, outpatient, or pharmacy services had an effect. The amount of the high deductible had a significant effect on all service categories for non-vulnerable families, but Haviland said the same was not generally true for the medically vulnerable. She explained that high-risk families reduced prescription drug spending only when deductibles were at least $1,000 per person.

The study was published online by the journal Forum for Health Economics & Policy.

See Also:
HDHPs Associated With 14% Decline in Health Spending