A few days ago over breakfast, my husband was perusing a job posting in his field. The company that posted the ad boasted a high salary, opportunities for advancement, a collegial work environment and a telework policy. After he finished reading the ad aloud, we looked at each other and said in unison, "What’s the catch?"

There’s always a catch, isn’t there? In the case of that job posting, the jury’s still out.

But there’s definitely a catch in the new study results from a team of RAND health researchers who assessed the spending patterns and health care use of high-deductible health plan participants.

The research, according to RAND, is the largest-ever assessment of HDHPs, studying more than 800,000 individuals during 2004 and 2005. 

The good news from the study affirms what we already know about HDHPs: they make users spend less on health care.

Health spending for families with a deductible of $500 per person or more dropped an average of 14% when compared with similar families in traditional health plans, RAND reveals.

In addition, cost savings increased even more for enrollees in plans with a deductible of at least $1,000 per person, and held steady when employers made moderate account contributions.
  
What’s the catch? It’s that as families reduced medical spending, they also dropped preventive care. Rates for childhood vaccinations, mammography, cervical cancer screening and colorectal cancer screenings all dropped among families with HDHPs — which is particularly head-scratching and troublesome, since most HDHPs waive the deductible for these types of care.

So, what gives? RAND researchers say "high deductibles may deter patients from seeking care for health problems that would prompt a referral for some preventive or screening procedure. Some patients may have sought preventive care outside their plan — through an immunization clinic, for example. Finally, first-year enrollees might not have understood that their deductible was waived for preventive care. It is possible that over time individuals will become more familiar with plan provisions, including benefit designs that encourage the use of preventive services."

What do you think of RAND’s findings? Are HDHPs destined to experience this type of catch-22 or can consumer education overcome such issues? And does it even matter, since PPACA requires plans to waive deductibles for preventive care anyway? Share your thoughts in the comments.

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