Cost-sharing health plans lead poor to make tough choices

CHICAGO (Reuters) - Poor families who sign up for high-deductible health plans are more likely to put off needed care than wealthier families, U.S. researchers said on Monday in a finding that suggests such plans may need to be revamped if they are to save health costs.

A team from the University of Pennsylvania surveyed people enrolled in Harvard Pilgrim Health Care, a New England-based health insurer, and found that lower-income families were just as likely as wealthier families to understand how their plan works, but they just could not afford to get treatment.

Enrollment in so-called high-deductible health plans, designed to save health costs by encouraging people to become savvy health consumers, is rising sharply as employers pass along the cost of healthcare to employees.

These plans have annual deductibles of at least $1,000 per person and $2,000 per family before most services are covered.

A survey of employers with at least 10 employees released earlier this month by employee benefits consulting company Mercer found enrollment in high-deductible plans climbed from 9 percent of all covered employees in 2009 to 11 percent in 2010.

"In the midst of the current economic downturn, many Americans are paying more for their health care," Dr. Jeffrey Kullgren and colleagues wrote in the Archives of Internal Medicine.

"One way in which a growing number of families are facing higher levels of cost-sharing for health care is enrollment in high-deductible health plans," they said.

In the study, the team found that low-income families were significantly more likely than wealthier families to delay or skip needed care for an adult or child.

They were also more likely than wealthier families to seek advice from doctors about whether a test was actually needed, even if it was a $100 blood test.

That is not because they did not understand their health plans. The team found poor families were no more likely than wealthier families to have difficulty understanding their plan.

They also asked survey participants how they would handle three different hypothetical health services not covered by their plan: a $100 blood test; a $1,000 colonoscopy or a $2,000 magnetic resonance imaging scan for back pain.

They found that poor respondents were twice as likely as wealthier respondents to discuss with their doctor the need for a $100 blood test or the cost of a $1,000 colonoscopy, a screening test for colon cancer.

"Based on data from patients from Harvard Pilgrim Health Care, the investigators find that lower-income families are more likely to delay or indefinitely postpone medical procedures than those with higher incomes," Dr. Victor Grann of the Mailman School of Public Health at Columbia University in New York wrote in a commentary.

Grann said the study sheds light on "the darker side" of high-deductible health plans.

He said the findings suggest the need for a "value-based model" of health insurance plans that charge less for tests or treatments that offer a high value -- such as screening tests -- and more for ones that offer less benefit.

"As we experiment with ways to increase value in health care, we must favor models that decrease incentives for use of inappropriate care and promote use of appropriate care," Grann wrote.

(Reporting by Julie Steenhuysen, editing by Anthony Boadle)