Consumer-Directed Healthcare: Except for the Healthy and Wealthy It's Unwise
Objectives: The authors explored the efficacy of consumer-directed healthcare - high deductible health insurance plans linked with health savings accounts.
Methods: The authors analyzed health spending data from the Medical Expenditure Panel Survey and calculated the median annual medical costs of men, women, various age groups, and people with a variety of medical conditions.
Findings: In 2006, the median health costs for women 18-64 were about $1000 higher than for men ($1,844 vs. $847). The difference was particularly striking among young adults (18-44), with median expenditures for women being nearly threefold higher than for men ($1,266 vs. $463). Middle-aged adults had far higher expenses than did young adults: for those age 45-64, the median expenditure was $2,871 for women and $1,849 for men. The authors also found that most individuals with even mild chronic conditions were likely to suffer financially in high deductible plans. For the 26.9 million Americans with high blood pressure, the median expenditure was $3,161. The median for the 9.7 million receiving any treatment for arthritis was $5,425, while the figure for the 5.2 million diabetics on any medication was $5,774. The 12.1 million children who took even a single prescription medication had median expenditures of $1,305.
Impact: The increasingly popular high deductible health plans are discriminatory against women, leaving them with far higher out-of-pocket health bills than men. Additionally, the authors found that adults 45-64, those with any chronic condition (such as asthma or high blood pressure), and children taking even one medication were very likely to suffer financially in high deductible plans. The plans offer little hope of slowing the growth of healthcare costs and add further bureaucratic costs and complexity to our healthcare financing system.
Background: Under high deductible health plans, patients are responsible for at least $1,050 (often $5000) in medical bills before insurance kicks in. These plans carry lower premiums than traditional coverage. The plans have been promoted as an important cost-saving strategy, in the hope that they will make patients more cost-conscious when they seek care. It has previously been recognized that young and healthy individuals stand to gain under high deductible policies, because few of them incur the high out-of-pocket costs.
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