Financial Barriers in High-Deductible Plans Hinder Access to Ambulatory Care

FOR IMMEDIATE RELEASE: Tuesday, November 1, 2016

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON, DC — High-deductible health plans discourage Americans with multiple chronic health conditions from seeking care and do little to shield them from medical debt, according to a Robert Graham Center analysis of data from the National Health Interview Survey.

The analysis, summarized in a one-pager titled “High-Deductible Plans May Reduce Ambulatory Care Use,” noted that people with high-deductible plans are likely to skip needed medical care and may accrue medical debt.

Researcher Anuradha Jetty, MPH, and her colleagues reviewed data from the National Health Interview Survey to analyze out-of-pocket expenses, medical debt, avoidance or delay of care, and the number of chronic conditions among people who had high-deductible insurance plans.

“Out-of-pocket expenses and medical debt increased with the number of chronic conditions,” Jetty writes. “Those with three or more chronic conditions were nearly three times as likely to delay or avoid care as those without chronic conditions. Delay or avoidance of necessary care risks earlier development of chronic disease complications or preventable disease.”

In the paper, Jetty and her colleagues note that high-deductible plans require patients to pay a specific amount – often up to several thousand dollars – before benefits kick in. Many also require co-insurance or copayments even after coverage starts. Finally, high-deductible plans offer narrow networks for health professionals and providers, which increases the chance of unexpected billing for out-of-network services, she writes.

“Medical debt is of greatest concern for individuals with chronic conditions, who use more health services,” Jetty says. “The Affordable Care Act health exchanges will increase the number of low-income Americans who have low-premium but high-deductible insurance, but who are more likely to be chronically ill and at risk of deferring services and accruing medical debt because of the high deductible.”

The researchers recommend that future policy should focus on the financial barriers to outpatient care.

“Now that the ACA has reduced the uninsured, policy makers should focus on mitigating the health and economic consequences of financial barriers to ambulatory and preventive care associated with high-deductible plans,” they conclude.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.