Medicare Compliance & Reimbursement

High-deductible plans have reduced medical costs but may encourage penny-pinching to a fault, studies suggest.

The divide that separates proponents of "consumer-driven" health care from traditional plans' staunch defenders grows wider by the day.

Three recent studies have shed new light on consumer-driven health plans' cost benefits. First-time CDHP beneficiaries have generated an 8-percent reduction in medical costs--all while making positive changes in health behavior, such as increasing their use of medications to treat chronic health care conditions, according to a Feb. 2 study from CIGNA Choice Fund. "This early data suggests that the change in health care decision-making encouraged by a consumer-driven plan doesn't end once a consumer satisfies the deductible or reaches the out-of-pocket maximum," says Michael Showalter, vice president of consumerism for CIGNA HealthCare.

But critics of consumer-driven health care are quick to point out that consumers' cost savings come at the expense of their own quality of care. Two additional studies give weight to these concerns. 4 Fundamental Flaws Plague Consumer-Driven Health Care There are four key reasons that consumer-driven health care isn't a good idea, the Center For American Progress asserts in a recent report.

First and foremost, consumer-driven health care "denies people the health care choices they really want," the center alleges. While 63 percent of benes in traditional plans are satisfied with those plans, only 42 percent are satisfied with their high-deductible, savings-account based health plans, finds a new "Consumerism in Health Care" survey from the Employee Benefit Research Institute and the Commonwealth Fund.

Medicare Part D's broad plan spectrum and consumer cost-sharing aspects represent another example of benes' dissatisfaction with consumer-driven care, notes CAP. "[E]arly experience has shown that 'choice' means confusion, unreliable information and continued high prices as seniors struggle to find plans that meet their needs," CAP remarks.

Second, consumer-driven health care discourages preventive and cost-effective care, disputes CAP. In an effort to reduce their out-of-pocket costs, consumers could become more likely to avoid preventive care as a cost-saving measure. "Skipping preventive services or skimping on drugs that manage chronic conditions could lead to higher overall health costs," the center points out. In addition, nearly 70 percent of the current system's costs are for the top 10 percent most expensive people, notes CAP. "These people's costs are well above the deductible, so a high deductible won't change their behavior."

CAP's third complaint is that consumer-driven care "assumes people use health care like they buy commodities." The problem with this methodology is that providers have as much to do with determining consumers' health care needs as consumers do themselves. Most tests, drugs and service use result from provider recommendations, not consumers' desires, notes CAP. Plus, when consumers' lives--or their loved ones' lives--are on the line, consumers with [...]