High-deductible plans seen as risky for kids

High-deductible health plans are risky for children, giving parents incentive to skip or delay necessary care, according to a policy statement adopted in March by the American Academy of Pediatrics' Committee on Child Health Financing.

HDHPs are growing in popularity because they are cheaper than PPO and HMO plans and can be paired with health savings accounts that allow patients to pay for out-of-pocket costs with pretax dollars. But the pediatrics committee said the plans put parents in the position of trying to determine when their children's care, especially preventive care, is necessary or financially worthwhile.

"We're making judgments for children" in pediatric care, said Steven E. Wegner, MD, chair of the AAP committee and a lead author of the report. HDHPs "are making parents think about every dollar when they may not understand the long-term benefits of preventive care."

A lack of preventive or regular well-child care can contribute to obesity, mental health problems and even juvenile delinquency, said Dr. Wegner, a Chapel Hill, N.C., pediatrician. The report says low- to moderate-income families, and families whose children have special health care needs such as juvenile diabetes or heart failure, are especially at risk.

The report states there is "insufficient information" of any adverse impact HDHPs are having on access to care, but Dr. Wegner said pediatricians have seen families "load up" on scheduled visits to save costs.

HDHPs should offer first-dollar coverage for preventive care and reimbursement amounts should be age-adjusted to recognize children's greater need for preventive services, the policy statement says.

At least some preventive care services are covered before the deductible is met for the three-quarters of patients in employer-provided HDHPs paired with health reimbursement accounts, and for 82% of those enrolled in HSA-qualified HDHPs, according to the Kaiser Family Foundation's 2006 National Employer Health Benefits Survey. The survey does not define the range of preventive services covered, and parents may still be required to make co-payments.

Greg Scandlen, CEO of the pro-HSA group Consumers for Health Care Choices, said he agrees with most of the AAP's recommendations, but said the report evinces physicians' uneasiness with change.

"Physicians for the first time are finding themselves accountable to their patients instead of just to insurance companies and I think that's a wonderful thing," he said.

While research on the effect of HDHPs on children is in short supply, a McKinsey & Co. survey of 2,500 patients found those in consumer-directed plans were 25% more likely to follow treatment regimens for chronic conditions, 20% more likely to participate in company wellness programs and 30% more likely to get an annual check-up. Other surveys, including one published by the Kaiser Family Foundation, found just the opposite.

Nearly 3.2 million individuals were enrolled in HDHPs as of January 2006, according to America's Health Insurance Plans, and the U.S. Treasury Dept. expects at least 25 million to be covered under the plans by 2010.

The AMA has policy supporting HSAs as one form of financing health care. The AMA also supports first-dollar coverage of preventive services.

"We don't want to be penny-wise and pound-foolish," said J. Edward Hill, MD, AMA immediate past president. "Prevention saves money and improves lives."