Published online November 1, 2006
PEDIATRICS
Vol. 118
No. 5
November 2006, pp.
2258
(doi:10.1542/peds.2006-1229)
Consumer-Driven Health Plans: Not All Bad
Shabnam Jain, MD
Department of Pediatrics and Emergency Medicine
Children's Healthcare of Atlanta
Emory University
Atlanta, GA 30322
To the Editor.—
I read with interest the commentary "Weighing the Risks of Consumer-Driven Health Plans for Families" by McManus et al.1 The authors correctly point out that high-deductible health plans (HDHPs) are not a panacea to the current problems in health care and are considered to favor the healthy and the wealthy. However, the downsides of HDHPs are overemphasized in the article, with little discussion of their potential benefits.
The primary purpose of HDHPs is to help reign in run-away health care costs, specifically by discouraging unnecessary use of health care resources. Studies have shown that, in general, increased use of health care resources is not directly correlated to improved outcomes.2 Evidence also suggests that overuse and misuse of health care are extensive, and significant savings can result by reducing such use.3 With current third-party payment systems, neither consumers nor providers have any incentive to curtail the use of wasteful services.
HDHPs place more responsibility for health care spending on the consumer, thus encouraging wiser choices. The fiscally conscious consumer would then expect providers to also make more cost-conscious and outcome-oriented decisions. Such consumers would curtail discretionary health care spending that is not covered but use more health-promoting services that would be covered. Early studies have not shown HDHP users to skimp on needed health care services.4
As pointed out by the authors, placing money in a health savings account to use until the deductible is met might be difficult for low-income families, and families with special health care needs would not save with HDHPs. However, overuse occurring in middle- and upper-income families would be reduced by HDHPs. The authors present a comparison of a hypothetical family's out-of-pocket expenses under HDHP and preferred-provider organization (PPO) plans. They fail to consider the deductible under most PPO plans, albeit a more modest one than in HDHPs. The total annual expenditure under an HDHP at $1382 is considerably less than the $2486 (including premiums) in the PPO plan, even after liberal use of office visits (8 per year, in addition to 6 preventive visits), specialist visits (4), and laboratory services (14). One would hope that an average family would not have such consumption of health care services. Indeed, it is such visits that are often optional, the use of which HDHPs would likely reduce.
Access to health services for all citizens is a laudable goal; provision of "health insurance" for every need is fiscally unsustainable. We can either provide basic health services for all or comprehensive services for some. Or, we can make health insurance what insurance was meant to be: coverage for major medical expenses but not minor illnesses, with special provisions for the impoverished and those with special health care needs and incentives for activities that actually promote wellness (preventive care).
The authors correctly state that issues of coverage, quality, and changes in practice administration will need to be addressed. If this can be done, HDHPs can offer a huge dose of accountability and a small degree of consumerism that our health care system urgently needs.
REFERENCES
- McManus MA, Berman S, McInerny T, Tang S-f. Weighing the risks of consumer-driven health plans for families.
Pediatrics. 2006;117
:1420
–1424[Free Full Text]
- Fisher ES, Wennberg JE, Stukel TA, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors.
Health Serv Res. 2000;34
:1351
–1362[ISI][Medline]
- Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality.
JAMA. 1998;280
:1000
–1005[Abstract/Free Full Text]
- Agarwal V, Mango PD, Packard KO. What employees think about consumer-directed health plans.
McKinsey Q. November 2005
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
