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High-deductible health plans are in part intended to cut down on unnecessary medical spending by putting more of a consumer’s dollars at stake. But there have been concerns that people who have low incomes or chronic diseases might cut back too deeply and scrimp on needed care.

A new study from the Rand Corporation finds that particular fear is unfounded, at least in the first year of enrollment, and in the group they studied — 360,000 families who signed up between 2003 and 2007.

Researchers looked at families living in low-income areas, and also those that included a person with a costly chronic disease, such as diabetes or kidney disease. And, lead author Amelia Haviland, a statistician at Rand, tells the Health Blog, there was no more cutting back among those vulnerable populations than there was among the group as a whole.

But these plans aren’t just supposed to decrease costs, they’re supposed to do it while also maintaining quality. And policyholders of all income levels showed a tendency to use recommended preventive services — such as cancer screenings and procedures for diabetics — less frequently when they switched to the high-deductible plan. This, despite the fact that preventive care doesn’t count against the deductible; the consumer bears none of the cost.

It’s possible, says Haviland, that because it was only the first year of the new plan, “people didn’t understand that [those services] were free.” That could change as they learn more about their plan. Or, she says, they aren’t seeing a doctor, and so aren’t being referred for those services. Either way, the kind of reductions in use seen in the study “are not good news,” she says. One exception: people with high-cost chronic health conditions were less likely to reduce cancer screenings.

High-deductible plans put “a greater burden on families to sort out … what is necessary and what is not necessary care,” Haviland says.

She notes that the effects seen in these families — which had at least one family member employed in a full-time job with benefits — may not carry over into other populations, such as the elderly or lower-income people who haven’t

The study is published online by Forum for Health Economics & Policy.

Image: iStockphoto

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