When Health Deductibles Rise, Men Delay Emergency Care

ANN CARRNS

NY Times, September 5, 2013

http://www.nytimes.com/2013/09/06/your-money/when-health-deductibles-rise-men-delay-emergency-care.html?ref=health

• Men, it turns out, are more likely to delay treatment for serious conditions under high-deductible plans, in contrast to women, who tend to be more selective and cut back care for minor ailments only.

• Such plans generally have lower monthly premiums than traditional health plans but higher out-of-pocket costs — sometimes, $4,000 or $5,000 for a family, or even higher. About 1/3 of workers now have such plans. And that number is likely to grow, since lower-cost plans on the new health care marketplaces created by the Affordable Care Act are likely to have relatively high deductibles.

Men Delay Care

Study of 12,000

• The study compared emergency room visits for about 12,000 people — roughly half men and half women — for a year before, and two years after, they were involuntarily switched by their employers to a high-deductible plan.

• For the first year after the switch, men’s use of the E.R. dropped across the board, even for severe conditions, like irregular heartbeat. Women cut back too, but mostly for less threatening symptoms, like headache or sore throats.

• Unfortunately, men also ended up with more hospitalizations in subsequent years, suggesting that they may have let a serious condition go untreated.

Some Key Questions

1. How can I use my high-deductible plan wisely?

Understand your benefits. Not all high-deductible plans are the same, and many cover preventive care outside of the deductible. Under the Affordable Care Act, all plans sold on the new marketplaces and many others must offer many preventive services free, like colorectal cancer screenings.

2. How should I decide when to seek treatment?

No one expects you to be a physician, but health plans increasingly offer sound online information that can help you learn about symptoms of serious situations, like a heart attack. “It’s very useful to know what your risk factors are,” said Ms. Kozhimannil (the researcher at the University of Minnesota School of Public Health) said. Most health plans also have nurse advice lines that can offer guidance, too.

Some Key Questions

3. What if I need care, but I’m worried I can’t pay for it?

Talk about this with your doctor, who might not know what cost burden you’re facing when you make decisions about proposed treatments. “Say to your doctor, ‘I have a high-deductible plan. Is there a different way to do this?' ” suggests Alison Galbraith, a doctor at the Harvard Pilgrim Healthcare Institute who has studied the plans.

Some Key Questions

The Economics

What does insurance do?

In this example, it typically gives a deductible and a copay.

Health

Other

H0

O0

Deductible

Copay

Suppose Deductible ↑, Copay same

Demand will decrease. We will now be on the “blue” budget constraint.

Increased deductible means we will be paying 100% of a higher amount.

Health

Other

H0

O0

Deductible

Copay