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HDHPs Pose No Additional Risk to Medically Vulnerable

Margaret Dick Tocknell, for HealthLeaders Media, April 19, 2011

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.

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2 comments on "HDHPs Pose No Additional Risk to Medically Vulnerable"


E. Richard Brown (4/19/2011 at 5:19 PM)
Although the journal article is clear that chronically ill subjects in their study had adverse effects of CDHPs, the accompanying Web article by Margaret Dick Tocknell seems to downplay this finding. The journal article clearly states: "High deductible plans also led to reduced spending on high value care for those at high risk. Of particular concern are findings that those at high risk in CDHPs received significantly fewer recommended cancer screening procedure, and diabetic patients in high deductible plans received fewer recommended procedures for diabetics. [In addition] those with chronic conditions in CDHPs, most of whom require drug maintenance, reduced spending on prescription drugs by more than other populations in CDHPs."

Helen Darling (4/19/2011 at 12:01 PM)
Even more important is the fact that this study is based on fairly old data and the trend has been to add more coverages for evidence-based preventive care at 100% before the deductible. If this study were based on data through 2011, I believe it would be even clearer that HDHPs have substantial benefits and members are not disadvantaged when sick.