Research: Families In High Deductible Plans More Likely To Delay Care

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Journal Of General Internal Medicine: Delayed And Forgone Care For Families With Chronic Conditions In High-Deductible Health Plans -- Researchers studied 208 families in high-deductible health plans (HDHPs) and 370 in traditional health plans who had children and at least one family member with a chronic condition. "The HDHPs in this study has family deductibles of $1,000 to $6,000 per year," and covered services such as emergency department visits, diagnostic tests and physical therapy. The traditional plans in this study did not have a deductible and averaged around $16 for a physician office visit co-payment. The authors observed "that the odds of reporting [delayed/forgone care] were three to four times greater for adults and children in HDHP families compared to traditional plan families" and they note that once the new health care law is implemented, "health insurance exchanges created by the Affordable Care Act (ACA) will likely include HDHPs" (Galbraith et. al., 1/18).

Archives of Internal Medicine: Overuse Of Health Care Services In The United States – This "special article" looks at more than 100 different studies related to the overuse of medication, procedures and tests. The researchers found 172 scientific articles on the subject but the majority of them focused on just four interventions: using antibiotics for upper respiratory infections and three heart procedures. They report that "the process of defining appropriateness for many services remains incomplete owing to both gaps in the evidence and failure to translate evidence into appropriateness criteria" (Korenstein et. al., 1/23).

Archives of Internal Medicine: Trends In Physician Referrals In The United States, 1999-2009 – This study examined how frequently doctors refer patients to other physicians and reports that the probability that someone seeking outpatient care would be referred to another physician rose from 4.8 percent to 9.3 percent between 1999 and 2009. The authors write that there were "significant increases noted for visits to primary care physicians from patients with cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms" and that it is not clear if the trend reflects "a change in the appropriateness of referrals. This is the result, in part, of the fact that little guidance exists on who to optimally define the appropriate use of referrals" (Barnett, Song and Landon, 1/23).

Morbidity and Mortality Weekly Report: Cancer Screening — United States, 2010 -- Government researchers culled data from a 2010 federal health survey to determine the demographics of breast, cervical and colon cancer screenings across the country. They found the rates of screening for each of these cancers were below the levels suggested by federal guidelines and varied by race: "Screening rates for all three cancer screening tests were significantly lower among Asians than among whites and blacks. Hispanics were less likely to be screened for cervical and colorectal cancer. Higher screening rates were positively associated with education, availability and use of health care, and length of U.S. residence." The report also says the 2010 federal health law "is expected to reduce financial barriers to screening by expanding insurance coverage" (Klabunde et al., 1/26).

Avalere Health: Drug Coverage In Essential Health Benefits Benchmark Plans: Formulary Analysis -- The authors write: "Given the wide variation in the availability of pharmaceuticals across different health insurance plans, decisions that states soon need to make on benchmarks for essential health benefits (EHB) could significantly affect the availability of drugs for individuals who purchase their insurance through health exchanges." Researchers found that, while HHS will require one drug/class minimum,  many plans already include more flexibility and choices, which "could result in significant plan-to-plan and state-to-state differences for consumers" (1/26).

Government Accountability Office: Coordinating Authority Needed For Psychological Health And Traumatic Brain Injury Activities -- This report finds that despite efforts at the Department of Defense to coordinate programs for wounded service members with post-traumatic stress disorder and brain injuries, "no single organization is devoted to ensuring that accurate and timely data is available." A 2008 RAND study showed similar results. The researchers said that without better coordination of the data, Defense will "remain hampered" when trying to use its resources effectively to meet the needs of the soldiers returning from Iraq and Afghanistan with brain injuries. It recommends that DOD "develop, maintain and coordinate quality control mechanisms" (1/25).

Health Affairs: Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs -- An assessment of the 2006 Massachusetts health reform shows improvement in decreasing the number of uninsured residents. According to this report, more than 94 percent of non-elderly state residents has insurance. It also finds other quality improvements in the system, including that employer-sponsored insurance has "remained strong," emergency department use has declined and hospitals stays have been reduced. However, the report notes that "Massachusetts continues to struggle with escalating health care costs, reflecting the decision to defer addressing costs in the 2006 legislation so as not to hold up the expansion in coverage" (Long, Stockley and Dahlen, 1/26).

KHN summarized news coverage of this study: Survey: Mass. Health Law Increased Coverage, But Struggles On Cost .

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