Published online November 1, 2006
PEDIATRICS
Vol. 118
No. 5
November 2006, pp.
2258a-2259
(doi:10.1542/peds.2006-2446)
Consumer-Driven Health Plans: Not All Bad: In Reply
Margaret A. McManus, MHS
Maternal and Child Health Policy Research Center
Washington, DC 20006
Stephen Berman, MD
Department of Pediatrics
Denver Children's Hospital
Denver, CO 80218
Thomas McInerny, MD
Department of Pediatrics
University of Rochester Medical Center
Rochester, NY 14627
Suk-fong Tang, PhD
Department of Practice and Research
American Academy of Pediatrics
Elk Grove Village, IL 60007-1098
We appreciate Dr Jain's thoughtful comments regarding our article on consumer-driven health plans. She believes that we overemphasized the risks of high-deductible health plans (HDHPs). Dr Jain views the increased cost-sharing requirements under HDHPs as a way to reduce overuse and misuse and bring more accountability and consumerism into the health care marketplace. However, she acknowledges that children from low-income families and children with special needs may face difficulties until their deductible is met.
Although early studies of HDHPs have shown few adverse effects, these studies have not specifically examined children at different family-income levels. Thus, we believe, the jury is still out on the effects of these plans on children.
With respect to our claim that the risks of HDHPs outweigh the benefits, we feel that this is reasonable for 2 reasons: (1) because of the significant out-of-pocket cost differentials compared with conventional health maintenance organization and preferred-provider organization (PPO) plans and (2) the failure of most HDHPs to cover preventive care before the deductible is met. In 2005, according to the Kaiser Family Foundation/Health Research and Educational Trust survey of employers,1 family deductibles were, on average, >5 times higher in HDHPs than in PPOs ($3686 vs $646, respectively). In addition, the same study found that only 30% of workers enrolled in HDHPs are covered for preventive care before the deductible is met. Clearly, families will face greater exposure to financial risk under HDHPs. In addition, if healthier families opt out of PPOs and health maintenance organizations in favor of HDHPs, those left behind will face higher premium prices.
We recognize that there is significant variability in service use among children, especially that related to emergency care, hospitalization, surgery, and prescription drug use. However, we do not believe that these problems are best solved through higher family cost-sharing. Previous research from the Rand Health Experiment2 and more recent experience with the State Children's Health Insurance Program3 reveals that increasing cost-sharing is associated with reduced use of essential care.
REFERENCES
- Kaiser Family Foundation; Health Research and Educational Trust.
Employer Health Benefits, 2005 Annual Survey. Menlo Park, CA: Kaiser Family Foundation; and Chicago, IL: Health Research and Educational Trust; 2006
- Newhouse JP. Consumer-directed health plans and the Rand Health Insurance Experiment.
Health Aff (Millwood). 2004;23
:107
–113[Abstract/Free Full Text]
- Artiga S, O'Malley M.
Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences. Washington, DC: Kaiser Commission on Medicaid and the Uninsured; 2005
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
