, Volume 27, Issue 9, pp 1097-1099

Who Pays? Cost-Sharing, Tradeoffs, and the Physicians’ Role in Decision Making

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In this issue of JGIM, Galbraith and colleagues describe the impact of high deductible health plans (HDHPs) on delayed or foregone care amongst families with chronic medical conditions. 1 They find that families in HDHPs are more likely to delay or forego care, compared to those in traditional plans. Patients in health plans with high out-of-pocket costs and with limited resources must, at times, make real tradeoffs. These tradeoffs raise a number of important questions. When families forgo health care, what are the consequences? When healthcare is not sacrificed, what is? And what should be the role of primary care providers in helping patients and their families face these decisions? In the setting of the rapid uptake of high deductible health plans 2 and continued economic turbulence, the answers to these questions have become more urgent.

The effects of HDHPs on health care utilization and outcomes are not well established. The RAND Health Insurance Experiment (HIE) in the 1970s sug