Could high-deductible plans today mean higher healthcare costs in the future?

The Health Savings Account (HSA) was created in 2003 as a way to help people pay for out-of-pocket healthcare expenses-up to $3,100 for individuals and $6,250 for families tax-free. This also ushered in the rise of high deductible insurance plans, with hopes that people would be more responsible for their own healthcare costs. The healthcare industry saw high deductible plans coupled with HSAs as the beginning of “consumer-directed” health plans.

More employers started offering high deductible plans and HSAs to employees. By 2010, more than half of employers offered at least one type of high deductible plan and 10 million Americans had signed up for them. The next year, 11.4 million patients had high deductible plans, a HSA, or both. From 2006 to 2012, enrollment in high-deductible plans tripled.

Healthcare costs continued to grow for everyone, though they grew at a slower rate for those with higher deductibles. A 2011 RAND Corporation study of more than 800,000 families found that healthcare spending dropped 14% for families with high deductible plans compared with families with insurance plans with lower deductibles.

But researchers also found drawbacks. Authors of the RAND study noticed that those families that were saving money on their healthcare costs were also seeing the doctor less for necessary treatments including preventative and wellness checkups and immunizations.

“We saw that patients reduced preventive care, and if this persists, it is likely to have health consequences in the future,” said Amelia Haviland, the study co-author. She added that some families went without preventative services even when there was no deductible for them. “These cutbacks could cause a spike in health care costs down the road if people end up sicker and need more-intensive treatment.”

Also, for people who chose high deductible plans because they cannot afford high monthly premiums, they could be delaying emergency treatment, which could lead to more hospitalizations in the future.

A study conducted in Massachusetts and published in the August 2013 issue of Health Affairs found that poorer people visited emergency departments 25% to 30% less for high severity issues in two years after signing up for high deductible plans. Hospitalizations for the group fell 23% in the first year, while rising again in the second year.

These studies suggest that consumers still need to be educated on the best way to use high-deductible plans and HSAs without sacrificing their health, which can lead to higher costs down the road.

“Policy makers and employers should consider proactive strategies to educate high-deductible plan members about their benefit structures or identify members at higher risk of avoided needed care. They should also consider implementing means-based deductibles,” the authors of the Health Affairs study stated.