High deductible health insurance plans in combination with health savings accounts were heralded as the best thing since generic drugs when they came on the scene in 2000. President Bush and his administration have praised the plans as being a great way to lower health insurance costs and encourage more consumer involvement in care. In general, health care is not something most people tend to pay much attention to until they’re sick, and then all they want is to find the first in-network doctor who will make them feel better. When Consumer Reports writes a comprehensive article about health insurance, it gets buried somewhere behind the reviews on cell phones and washing machines. I don’t know many people who are likely to call around and comparison shop for health insurance. And even if you are so inclined, it can be tough to get any real information about cost until after the treatment is complete.
So while it would be nice to think that everyone who gets an HDHP is also setting up an HSA, funding it little by little until the account has enough money stashed away to cover the deductible, and then shopping around diligently for health care and avoiding unnecessary treatment – the reality is a bit different. Many of our Colorado clients who enroll in an HDHP do not set up an HSA. They are getting the HDHP because health insurance premiums have gotten so far out of reach that for many people, a high deductible, bare-bones policy is all they can afford. There is no money left over to fund the HSA. So when the time comes to pay the high out-of-pocket expenses that come with an HDHP claim, a payment plan is the only option (granted, this is far better than not having health insurance at all and being stuck with the entire bill).
Now researchers at the University of Oregon have found that people with high deductible health plans are two to three times more likely to stop taking medications to control chronic conditions, compared with patients who are on traditional health insurance plans. Specifically the study looked at medications used to lower blood pressure and cholesterol. The idea behind the HDHPs was that patients would act as consumers – opting for generic drugs on a more frequent basis, and shopping around before choosing a provider. This does not appear to have happened – instead, patients seem to be looking for the fastest way to save money on health care costs. In the case of drugs that lower blood pressure and cholesterol, going off the medication won’t have a short-term effect on most people. So it may seem like a good solution when money is tight and the entire cost of the medication is out of pocket. Unfortunately, uncontrolled hypertension and cholesterol can have many far reaching implications over time, from both health and money perspectives.
If HDHPs keep people from going to the doctor when they have a cold, that’s a good thing. But if it means that more people are running around with uncontrolled high blood pressure, that’s not so good. One would like to think that the proliferation of HDHPs and HSAs would help curb our overuse of medical treatment, encourage generic drug use, and help lower the overall cost of health care and health insurance. But it doesn’t seem to be working, at least not yet. Personally, I’m a big fan of the HDHP/HSA. Jay and I have one for our family, and I love the simplicity of it. It is less expensive than a traditional plan, and we do not go to the doctor unless something is seriously wrong, so it works well for us. But this recent research about people discontinuing treatment of chronic conditions should give pause to the government officials who are encouraging widespread use of HDHPs as a way to control health insurance costs.