High‑Deductible Health Plans Drive Sicker Patients and Ration Care

Hear’s a breakdown of the key arguments presented in the text, focusing on High Deductible Health Plans (HDHPs) and “skin in the game”:

The Original Theory:

* Economists, referencing the RAND Health Insurance Experiment, believed that cost-sharing (like high deductibles) would encourage patients to be more price-conscious consumers of healthcare.
* The idea was that having “skin in the game” – meaning patients paying more out-of-pocket – would lead to them shopping around for the best prices and avoiding unnecessary care, ultimately lowering overall costs.

The Reality:

* The text argues this theory has failed. Rather of payers (insurance companies) saving money, patients are bearing the brunt of the costs.
* HDHPs don’t lead to cost containment but rather cost deferral. People spend less initially, but this is because they are delaying or foregoing necessary care.
* Studies in Health Affairs and JAMA show hdhps reduce the use of all types of healthcare services – preventative, chronic, and discretionary.
* Examples of cost deferral: Patients delaying gallbladder surgery, not taking necessary medication for conditions like high blood pressure or arrhythmias, and arriving at the hospital in critical condition as a result.
* The result is that care isn’t actually cheaper; it’s just less accessible to people.

Current Trend:

* This same cost-shifting design (high deductibles) is now being implemented in physician benefit packages.

In essence, the article contends that the “skin in the game” approach, while intended to control costs, has primarily made healthcare less affordable and accessible for individuals, leading to potentially worse health outcomes.