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High deductibles are bad for our health. What’s the remedy?

Ashok Subramanian

May 12, 2021


Let’s be honest; if you have a health plan with an $11,000 family deductible, you are functionally uninsured.


How so? Let’s do the math. If most Americans have about $400 saved, that’s a $10,600 gap that only the wealthiest among us have socked away. FSAs and HSAs can help, but only if you have the extra money to put towards one; exactly what most working Americans living paycheck to paycheck do NOT have. No wonder a full one-third of the money raised on GoFundMe is for medical expenses, the organization’s largest single category.1


The math is bad enough. But what about the real human toll? Evidence that clinical outcomes are worse for those with high deductibles is as clear as it is mountainous.


Consider:


  • Women with breast cancer who switched to high-deductible health plans before being diagnosed experienced delays in every aspect of the care process, and regardless of income (the delays were just longer the lower the income).2
  • High out-of-pocket costs have caused many of those with epilepsy to disrupt their usage of antiepileptic medications – which of course actually increases health complications and overall related health spending down the line.3
  • Rheumatologists report that people often skip therapy treatments at the beginning of the year, when deductibles have not been met, with no correlation to severity of symptoms.4

Some anecdotal comments are even more disturbing, like this quote from a recent JAMA article, “…diagnosis and treatment (of patient’s serious symptoms) were delayed due to the patient’s hesitation to undergo testing because of financial concerns regarding his high deductible.”5


Or this comment from a reader based on an online NPR story, “Scheduled to have an MRI, but considering canceling because deductible is unmet. Wife’s suppose (sic) to have a colonoscopy and is going to cancel as well.”6


So simply put, high deductibles cause not only financial hardships, but they are also bad for our health. Not to sound too cynical, but a health benefit plan design feature that negatively impacts health outcomes seems to be at best counterintuitive.


There is a more logical way that leads to better outcomes, both financial and clinical, for employers, employees, and providers. The model empowers necessary and affordable care via a health plan with no deductible (high or otherwise), no coinsurance (another financial bugaboo lurking in the HDHP closet), free primary care, and a comprehensive yet simple and easy to understand copay schedule.


We built our health plan offering based on this model at Centivo by aligning with providers who have made significant strides in both cost efficiency and effective care, and who want to bring this success to the employer-sponsored market.


In an upcoming post, my colleague and Centivo’s Chief Medical Officer, Dr. Wayne Jenkins, will discuss free primary care, and why it is so crucial to addressing affordability, access and overall population health (and while we are at it, let’s talk referrals too).


1 CBS News, January 28, 2019 “Their twins medical costs total $750,000 – each. They and thousands of others are counting on GoFundMeby Megan Cerullo.

2 Health Affairs, April 22, 2019 “The Challenges of High-Deductible Plans for Chronically Ill People” by Kenneth E. Thorpe, et al.

3 Health Affairs, April 22, 2019 “The Challenges of High-Deductible Plans for Chronically Ill People” by Kenneth E. Thorpe, et al.

4 Health Affairs, April 22, 2019 “The Challenges of High-Deductible Plans for Chronically Ill People” by Kenneth E. Thorpe, et al.

5 JAMA Internal Medicine, March 8, 2021 “Avoiding a Crisis With High-Deductible Insurance Plans – A Teachable Moment” by Jenny A, Shih, MD and Katherine C. Wrenn, MD.

6 https://www.reddit.com/r/science/comments/bepu9t/highdeductible_health_policies_linked_to_delayed/

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