3. There Is Ample Evidence That People Are Forgoing Medical Care Due To Cost.
A Thomson Reuters phone survey of 12,000 households in 2009 found that 20 percent of people cited delaying or postponing care due to cost concerns. Survey data from Families USA published this year suggests similar behavior: 25 percent of people avoided needed care—tests, treatments, follow-up care, and prescription drugs—because they could not afford it. At least equally important is the observation that lower to middle-income individuals appeared more likely to forgo care. This is further confirmed by a RAND study that found lower-income people more likely to defer or avoid care.
These pieces of evidence shine a new spotlight on the perception of health care services as more elastic than they should be. Hence they compete with other household priorities that require out-of-pocket expenses.
4. Not Complying With The Recommendations Of Care Providers Is Problematic.
That not following doctors’ orders is detrimental may be an obvious statement. This notion is worth reiterating in the context of HDHPs, however, especially since noncompliance was neither the driving philosophy of these benefit plans, nor a desired byproduct.
In some plans, including those consumer-directed health plans with a health savings account, out-of-pocket expenses apply to prescription drugs as well, which may result in patients not filling prescribed medications. This phenomenon is especially troubling among the chronically ill, for whom following through with necessary medications and tests is vital for disease maintenance. Indeed, a recent Deloitte white paper suggests that provider-initiated disease management programs and the improvement in quality ratings may suffer, when patient compliance is challenged by high cost-sharing.
The RAND study cited before also articulated a potentially hazardous vicious circle: individuals in poorer health tend to be ordered more medical services that can result in comparatively greater financial burden, leading to noncompliance, which in turn sustains adverse health.
5. Some Studies Suggest A Negative Impact To Utilization In The Long Run Due To Avoidance Of Necessary Care In The Short Run.
A 2013 study published in Med Care by Katy B. Kozhimanill et al. sheds light on how HDHPs can affect emergency room utilization and hospitalizations, based on the behaviors of over 10,000 patients one year before and two years after switching from a traditional health maintenance organization (HMO) plan to HDHPs. The results showed that compared to a control group, female and male patients in the study reduced emergency room (ER) use by 11 percent and 19 percent, respectively.
The reduction in female ER use was mostly in low-severity visits—generally indicative of patients avoiding discretionary care due to high personal costs—while males avoided both low-severity and high-severity utilization. Typically, high-severity visits represent essential care that should not be deemed optional, thus the authors identified the trend among male patients as a cause for concern. Not surprisingly, the authors cited that hospitalizations among males increased by 30 percent in the following year, possibly illustrating the negative consequences of putting off necessary services.
In another study, Paul Fronstin et al. explored medication utilization and adherence in chronically ill patients enrolled in consumer-directed health plans with a health savings account (HSA). When compared to a control group of preferred provider organization (PPO) members, medication adherence fell in the first year of enrollment for patients with hypertension, dyslipidemia, diabetes, and depression.
