Consumer-directed health plans can reduce healthcare use and lower costs, but it is debatable whether these high-deductible plans can accomplish this without deterring consumers from seeking needed care, according to a RAND Corporation study published on the Health Affairs web site. RAND researchers estimate that if all privately insured, nonelderly Americans were moved from low-deductible health insurance plans to consumer-directed plans, the result would be a one-time reduction in healthcare utilization of 4% to 15%. However, pairing such high-deductible plans with health savings accounts could offset those reductions by as much as half.
Although people who pay more out-of-pocket for health care tend to spend less on “inappropriate” or “unnecessary” care, it’s not known whether these plans will deter people from getting necessary and needed health care. The 1974-82 RAND Health Insurance Experiment found that increased cost-sharing prompted consumers to forgo appropriate and inappropriate care alike--but with no apparent adverse health effects. RAND is undertaking a four-year, $4 million study co-sponsored by the California HealthCare Foundation and the Robert Wood Johnson Foundation to examine the effect of high-deductible health plans--with and without spending accounts--on use and quality of care, including differential effects based on health status, income, and other factors.
