The Impact of High Deductibles on Healthcare – A Trend to Watch

By Rose O. Sherman, EdD, RN, FAAN

2014 marked one of the first years in recent decades where there as a noticeable slowdown in healthcare spending.  Initially, most of the slowdown was attributed largely to the movement of reimbursement to a value-based system.  On closer examination, healthcare economists now suggest that the bigger impact factor in the slowdown of spending is related to the rise of high deductible insurance plans.  High-deductible plans have proliferated in the employer space, and they are also a commonly chosen option on the Patient Protection and Affordable Care Act exchanges.  More than 13.5 million Americans now have these plans.

According to a recent Commonwealth Foundation Brief – in 2013, the average deductible for a single employee in an employer plan was $1,273—a 146% jump from than an average of $518 in 2003 but many have deductibles that are much greater.  With higher deductibles, the utilization of all healthcare services including hospitals has decreased for those under the age of 65.  Markets where Medicare is not a primary payer have seen the largest drops in utilization because they are most impacted by changes in employer plans and individual consumer decisions about where and when to use services based on costs.

Impact on Use of Care

The California Health Foundation has studied the impact of high deductibles on how individuals use care.  Their  findings show that consumers in these plans become more sensitive to costs and are less likely to seek services. They are also more likely to demand transparency about the costs of services.  In many cases, this can be a good thing.  If the care they are cutting back on is truly unnecessary, they benefit from lower costs and less exposure to medical risk. However, if consumers are forgoing needed care which in some cases they do, they could be endangering their health and may need more intensive treatment later. What is not yet clear is whether this is a first year phenomenon or a true bending of the cost curve. The result could in fact be a spike in health care costs down the road.

A Trend Worth Watching

Healthcare economists predict that there are strong forces to continue to drive the use of high deductible health plans.  In areas where these plans predominate, you will be likely to see a drop in the use of high cost services providers such as emergency rooms.  Sirona Healthcare which provides nurse advice line services have seen an increase in requests from patients for care that does not involve using an emergency services vehicle or emergency room.  In some cases, this can be a patient safety issue where the primary decision driver from the consumer perspective is cost.

This will be important policy trend for nurse leaders to watch.  Can an effort to have “consumers have skin in the game to reduce costs” ultimately result in poorer health care outcomes?