Employers looking to curb the cost of health care may be deploying more high-deductible health plans (HDHP), but the resulting price concerns may be doing more harm than good, and not just because of patients delaying care.

The Physicians Advocacy Institute (PAI) published a new survey this month conducted by NORC at the University of Chicago, which solicited responses from more than 700 independent physicians who are not currently employed by a hospital or health system. Per the report, the average deductible for covered workers has risen 212% between 2008 and 2018, with premiums for employer-sponsored insurance increasing by 55% during the same period.

The added financial responsibility was supposed to make consumers more engaged in their health care decisions, but that just hasn't been the case. Among the physicians surveyed, 80% say patients have refused or delayed care care due to the cost, and 79% say that HDHPs are to blame.

"High-deductible health plans were supposed to make us better health care consumers, but they have failed," said Donald J. Palmisano, Jr., executive director and chief executive officer of the Medical Association of Georgia."They force people attracted by low premiums to choose between health care and housing, or food. They're an idea that turned out to be bad for both patients and doctors."

While both employers and their employees may have been drawn to these plans by lower premiums, those choices can generate long-reaching complications for both patients and doctors. According to the study, "HDHPs increase provider responsibility to collect patient out-of-pocket payments, explain benefits, and help patients anticipate costs."

According to the survey, physicians are making other changes to their care recommendations based on a client's financial situation. These include:

66% have changed their decision to prescribe a drug
61% changed the type of medical treatment
86% changed what type of drug they prescribed

Per the report, only 15% of all physicians surveyed feel they are very prepared to have financial discussions with patients, while 75% say they don't have the information needed to discuss the cost of care with patients. Even literature or other informational materials that could help patients make informed decisions may be in short supply, and just 40% of physicians offer tools to help patients understand costs.

As a result of the uncertainty around costs, physicians may be changing their treatment approach while patients could be negating or postponing health care treatment altogether. The survey indicates that 52% of physicians surveyed often change which drugs they prescribe due to patient cost concerns, while 44% said that they sometimes change the type of treatment provided for the same reason.

When asked in their opinion how often patients refused or delayed treatment due to cost concerns, 20% of physicians surveyed said "often" and 60% indicated "sometimes." When patients do opt to go ahead with treatment, recovering the payment can become challenging for providers. Among physicians surveyed, more than 40% said it takes 60 days or more to receive a payment.

"Before COVID-19, patients had to delay or forego medical care due to the financial challenge of satisfying their insurance plan's high deductible," Kelly Kenney, chief executive officer of the Physicians Advocacy Institute said in a press release. "The pandemic has made it clear that making patients wholly responsible for thousands of dollars their insurance plan used to cover benefits no one but insurers."

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High-deductible health plans are popular but costly to patients

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