It sounded like a promising way to contain soaring health care costs in the U.S.:
Create insurance plans with high deductibles so patients would have “skin in the game”
and think twice about using health resources.
But like many seemingly good ideas, there are unintended consequences: Patients skimp
on preventive services, get sick and face costlier treatments.
John D. Lantos, M.D., FAAP, will discuss these types of insurance plans and what they
mean for pediatricians during a session titled “No Can Do, Doc! I Have a High Deductible
(F2086)” from 2-2:45 p.m. Sunday, Nov. 4, in room W311GH of the convention center.
A high-deductible health plan (HDHP) has a deductible of at least $1,350 for an individual
or $2,700 for a family, according to the IRS. Yearly out-of-pocket expenses (including
deductibles, copayments and coinsurance) are capped at $6,650 for an individual or
$13,300 for a family. The limit, however, doesn't apply to out-of-network services.
The percentage of adults ages 18-64 with employment-based coverage enrolled in an
HDHP increased from 26% in 2011 to 39% in 2016, according to the Centers for Disease
Control and Prevention’s National Center for Health Statistics. And nothing indicates
the rise in these plans is going to stop, said Dr. Lantos, a member of the AAP Section
on Bioethics and Committee on Pediatric Research.
“We tend to think of people as either being insured or not being insured. HDHPs leave
people ‘under-insured,’” Dr. Lantos said. “Thus, they cannot get the medicines that
we prescribe or the tests we order. They may not be able to pay doctors’ bills. Underinsurance
is a major cause of bad debt for doctors and hospitals, and a major cause of medical
bankruptcies for patients.”
During the session, Dr. Lantos will talk about why these plans came into existence,
the problem of cost control in medicine and the difference between high-deductible
health plans and value-based insurance design.
“Doctors need to be aware that more and more patients, even those with seemingly comprehensive
employer-based insurance plans, may be under-insured and may not be able to afford
needed tests or medications,” said Dr. Lantos, professor of pediatrics, University
of Missouri-Kansas City, and director, Children's Mercy Hospital Bioethics Center,
Kansas City, Mo. “We should talk to our patients to help them understand — and to
make good choices (if they have a choice) — about what sort of insurance they need.”