Consumer Awareness and Strategies Among Families with High-deductible Health Plans
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High-deductible health plans (HDHPs) are a new and controversial approach to increasing the share of health care costs paid by patients. Our study had the following aims: (1) to describe the experiences of families with HDHPs who had incurred high out-of-pocket costs and (2) to identify areas where clinicians could support more effective health care decisions by such families.
We conducted four focus groups with adults whose families had HDHPs in a New England-based health plan and had experienced high or unexpected out-of-pocket health care costs during the past 12 months. Transcripts of audio recordings were independently coded by three investigators using modified grounded theory techniques.
The 21 focus group participants had a good general understanding of how their HDHP worked, but reported confusion about specific processes due to the plans' complexity. They described heightened awareness of health care costs, and identified important barriers to their ability to control costs. These included needing to seek care for urgent problems without having the time to assess potential costs; having mistaken expectations about what services the HDHP covered; and being reluctant to discuss costs with doctors. They attempted to control costs by delaying or avoiding visits to doctors, but felt they had little control over costs once a clinical encounter had begun.
Patients with HDHPs reported heightened sensitivity to health care costs, and described important barriers to their ability to make effective choices. Helping such patients make optimal decisions will likely require systems-level changes that involve clinicians and health insurers.
KEY WORDShealth policy health insurance health care reform costs decision-making
We are grateful to Bruce Landon, MD, MBA, Meredith Rosenthal, PhD, and Christopher Forrest, MD, PhD, who offered very helpful advice as consultants. We thank Stephen Soumerai, ScD, and Dennis Ross-Degnan, ScD, for support and guidance in this project. We thank Pamela Butler for assistance with the manuscript.
This study was supported by an R21 grant from the National Institute of Child Health and Human Development (HD053440). Dr. Lieu's effort was supported in part by a K24 Mid-Career Development Award from NICHD (HD047667). Dr. Galbraith's effort was supported in part by a K23 Mentored Career Development Award from NICHD (HD052742).
Conflict of Interest
- 4.Claxton G, Dijulio B, Finder B, et al. Employer Health Benefits; 2008 Annual Survey. Menlo Park, CA and Chicago, IL: Kaiser Family Foundation, Health Research & Educational Trust; 2008.Google Scholar
- 5.Kaiser Family Foundation. Percentage of Covered Workers Enrolled in High-Deductible Plans, 2008. http://facts.kff.org/chart.aspx?ch=708. Accessed October 23, 2009.
- 9.Blumberg LJ, Clemans-Cope L. Health Savings Accounts and High-deductible Health Insurance Plans: Implicatins for Those with High Medical Costs, Low Incomes, and Uninsured; Timely Analysis of Immediate Health Policy Issues. Princeton, NJ: Robert Wood Johnson Foundation; 2009.Google Scholar
- 12.Harvard Pilgrim Health Care. The Harvard Pilgrim Best Buy HMO - Massachusetts. https://www.harvardpilgrim.org/pls/portal/docs/PAGE/SC/COVERAGE/BESTBUY/CC1686_BB_HMO_MA.PDF. Accessed October 23, 2009.
- 13.Crabtree B, Miller W. Doing Qualitative Research. 2nd ed. Newbury Park, CA: Sage Publications; 1999.Google Scholar
- 17.Harvard Pilgrim Health Care. Harvard Pilgrim Health Care is #1 commercial health plan on U.S.News & Worl Report/NCQA "America's Best Health Plans" 2008 list. https://www.harvardpilgrim.org/portal/page?_pageid=213,261343&_dad=portal&_schema=PORTAL. Accessed October 23, 2009.