High-deductible health plans' effect same for rich and poor

Patients with low incomes or chronic conditions who are covered by high-deductible health plans are not likelier than well-to-do or healthy patients to skip preventive care, said a study published in April.

Researchers examined data shared by 59 large U.S. employers from 2003 to 2007, comparing the health care use of nearly 370,000 families covered by a variety of plans with low, moderate and high deductibles.

Patients enrolled in the high-deductible plans slashed their health spending by as much as 29%. But the drop in spending was similar among families below 200% of the poverty line and those above it, said the study, published in the Forum for Health Economics & Policy.

Use of preventive care such as cancer screenings and hemoglobin A1c tests for diabetics fell by as much as 10%, but the drop was similar for well-to-do households and those with lower incomes. Patients with a costly chronic condition such as heart disease or hypertension had the smallest drops in spending and use of preventive services.

"We have at least some evidence that medically recommended care is being reduced, but I think on the whole it's a positive message," said Roland McDevitt, PhD, who co-wrote the study with researchers from RAND Corp. and the University of Southern California. "It looks like we're not seeing a disproportionate effect on vulnerable populations."

More than 10 million people are enrolled in high-deductible plans, says a May 2010 report by America's Health Insurance Plans. That figure is likely to rise as employers seek to cut their medical costs, said McDevitt, director of health care research at consulting firm Towers Watson.

The American Medical Association has policy supporting health savings accounts, which are often paired with high-deductible plans, as one form of financing health care. The AMA also supports first-dollar coverage of preventive services.