Spike has done his homework. UPDATE – well, Spike actually quoted a different report, not the original McKinsey one. I should have done some source checking, did not, and apologize for the oversight.) In response to a comment from another reader (Michael Trapier), he read the entire article by McKinsey on CDHPs et al. Here’s Spike’s quote from the article, which deserves its own post. (again, turns out this quote was from an EBRI research report), and read the comments below:
“While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. The survey asked whether in the last year respondents had delayed or avoided getting health care services when they were sick because of costs. About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent).
Having a health problem made it more likely that people avoided or delayed care. Among people who reported being in fair or poor health or having at least one chronic health condition, those in CDHPs or HDHPs reported delaying or avoiding care at higher rates than those in comprehensive plans: 40 percent of those in CDHPs and 31 percent of people in HDHPs, compared with 21 percent in comprehensive plans. People with HDHPs and CDHPs in households with incomes of under $50,000 were also more likely to avoid or delay care: nearly half of those in CDHPs and more than two in five in HDHPs reported delaying or avoiding care, compared with one-quarter (26 percent) of those in comprehensive plans in that income range.
In addition to delaying or avoiding health care, people in HDHPs were significantly more likely to skimp on their medications than were those in comprehensive plans. The survey asked respondents whether in the last 12 months they had not filled a prescription because of costs. More than one-quarter (26 percent) of those with HDHPs said they had not filled a prescription because of cost, compared with 16 percent of those in comprehensive health plans (Figure 17). Having a health problem made it more likely that people avoided filling prescriptions, particularly those with HDHPs: One-third of those in HDHPs with health problems had not filled a prescription because of cost, compared with one-fifth (21 percent) of people in comprehensive plans.”
That’s a (rather lengthy) quote from the study you cited. In fact, that whole study talks about how total healthcare use is the same for each group, but out of pocket costs are way higher for those in CDHPs and that people in comprehensive group care found that their plan made it easier for them to incpororate costs into their decisions about treatment.
As for health economics, the reality is that as long as there is EMTALA, (which says that hospitals must treat patients in need of emergency care regardless of their ability to pay), creating systems where preventive pay is discouraged will only be more expensive for all of us. And I don’t see anybody having the political will to void EMTALA. We’re all in this together, whether you like it or not.”
That’s a lot of good work, Spike.
Notably, the time period for the study did not enable the researchers to identify changes in health care costs over time. One has to wonder if the failures to comply with drug regimens etc. would actually lead to increased health care costs over time. Actually, you don’t have to wonder.
BTW – the McKinsey report also notes that CDHPs did have a substantial correlation with participants’ awareness of costs; desire to seek alternative treatment, and likelihood of involvement in healthy behaviors. But I wonder if the latter was not an artifact, and if the participants’ healthy behaviors made it more likely that they would select CDHPs.
What does this mean for you?
More evidence that CDHPs will do nothing to reduce medical expenses.
Feb
13
Joe, my quote was actually from this article
“Early Experience With High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey”, not the one Trap cited.
My apologies, obviously.
However, I’ve read the McKinsey report. The obvious hole to poke in it is that all of their data is based on self-reports from the study participants. People who have been in HRAs for over a year might be more likely to say they were more compliant than those in comprehensive group coverage due to the expectation that because they are in a CDHP they are “supposed to” take more control over their health, whether they do or not. Because the study is not based on claims data, there is simply no way to determine if either group actually did comply with preventive care like mammograms, basic blood work, annual physicals, etc. Nor is there any way to determine if one group actually was less expensive than the other. The study as a whole is pretty inadequate when it comes to actually describing their method. They don’t give us an example of the questions asked and they don’t break their data down into anything very meaningful.
I’d say the McKinsey report says little except for that people in HRAs understand how they are supposed to feel, and that McKinsey stands to gain economically from the adoption of CDHPs, based on their obvious cheerleading in this study.
Anyway, again I apologize for mixing up the articles. Consider the other study a rebuttal of your point, Trap, rather than the clear refutation I thought it was.