High-Deductible Health Plans and Better Benefit Design
Authors: Anish P. Mahajan, Robert H. Brook
Journal: Annals of Internal Medicine (2008)

Editorials6 May 2008High-Deductible Health Plans and Better Benefit DesignAnish P. Mahajan, MD, MPH and Robert H. Brook, MD, ScDAnish P. Mahajan, MD, MPHFrom The Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and RAND Corporation, Santa Monica, CA 90407.Search for more papers by this author and Robert H. Brook, MD, ScDFrom The Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and RAND Corporation, Santa Monica, CA 90407.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-9-200805060-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail High-deductible health plans are growing in policy and market prominence. These plans offer lower premiums than conventional insurance products but make enrollees pay high deductibles (the amount that a person must pay out-of-pocket before their health insurance plan pays benefits) for most types of care, including emergency department use, inpatient hospital services, diagnostic testing, and pharmaceuticals. Average deductibles in high-deductible health plans range from $1600 to $1900 for individuals and $3300 to $3900 for families. In 2007, approximately 10% of employers offered high-deductible health plans, and such plans covered about 3.8 million workers (1). By shifting more of the cost ...References1. Claxton G, Gabel J, DiJulio B, Pickreign J, Whitmore H, Finder B, et al. Health benefits in 2007: premium increases fall to an eight-year low, while offer rates and enrollment remain stable. Health Aff (Millwood). 2007;26:1407-16. [PMID: 17848452] CrossrefMedlineGoogle Scholar2. Newhouse JP; The Insurance Experiment Group. Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge, MA: Harvard Univ Pr; 1993. Google Scholar3. Lohr KN, Brook RH, Kamberg CJ, Goldberg GA, Leibowitz A, Keesey J, et al. Use of medical care in the RAND Health Insurance Experiment. Diagnosis- and service-specific analyses in a randomized, controlled trial. Med Care. 1986;24:S1-87. [PMID: 3093785] MedlineGoogle Scholar4. Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med. 2008;358:375-83. [PMID: 18216358] CrossrefMedlineGoogle Scholar5. Goldman DP, Joyce GF, Escarce JJ, Pace JE, Solomon MD, Laouri M, et al. Pharmacy benefits and the use of drugs by the chronically ill. JAMA. 2004;291:2344-50. [PMID: 15150206] CrossrefMedlineGoogle Scholar6. Chernew ME, Rosen AB, Fendrick AM. Value-based insurance design. Health Aff (Millwood). 2007;26:w195-203. [PMID: 17264100] CrossrefMedlineGoogle Scholar7. Benedetti NY, Fung V, Reed M, Price M, Brand R, Newhouse JP, et al. Office visit copayments: patient knowledge, response, and communication with providers. Med Care. 2008;46:403–9. [PMID: 18362820] CrossrefMedlineGoogle Scholar8. Wharam JF, Galbraith AA, Kleinman KP, Soumerai SB, Ross-Degnan D, Landon BE. Cancer screening before and after switching to a high-deductible health plan. Ann Intern Med. 2008;148:647-55. LinkGoogle Scholar9. Busch SH, Barry CL, Vegso SJ, Sindelar JL, Cullen MR. Effects of a cost-sharing exemption on use of preventive services at one large employer. Health Aff (Millwood). 2006;25:1529-36. [PMID: 17102176] CrossrefMedlineGoogle Scholar10. Rowe JW, Brown-Stevenson T, Downey RL, Newhouse JP. The effect of consumer-directed health plans on the use of preventive and chronic illness services. Health Aff (Millwood). 2008;27:113-20. [PMID: 18180485] CrossrefMedlineGoogle Scholar11. Lafata JE, Divine G, Moon C, Williams LK. Patient-physician colorectal cancer screening discussions and screening use. Am J Prev Med. 2006;31:202-9. [PMID: 16905030] CrossrefMedlineGoogle Scholar12. Nadel MR, Shapiro JA, Klabunde CN, Seeff LC, Uhler R, Smith RA, et al. A national survey of primary care physicians' methods for screening for fecal occult blood. Ann Intern Med. 2005;142:86-94. [PMID: 15657156] LinkGoogle Scholar13. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al; American Cancer Society Colorectal Cancer Advisory Group. the US Multi-Society Task Force. the American College of Radiology Colon Cancer Committee. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;:. [PMID: 18322143] CrossrefMedlineGoogle Scholar14. Karter AJ, Stevens MR, Herman WH, Ettner S, Marrero DG, Safford MM, et al; Translating Research Into Action for Diabetes Study Group. Out-of-pocket costs and diabetes preventive services: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2003;26:2294-9. [PMID: 12882851] CrossrefMedlineGoogle Scholar15. Bodenheimer T. The Oregon Health Plan—lessons for the nation. First of two parts. N Engl J Med. 1997;337:651-5. [PMID: 9271486] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and RAND Corporation, Santa Monica, CA 90407.Disclosures: Dr. Brook's wife, Dr. Jacqueline Kosecoff, is CEO of Prescription Solutions.Corresponding Author: Robert H. Brook, MD, ScD, The RAND Corporation, 1700 Main Street, Santa Monica, CA 90407; e-mail, [email protected]org.Current Author Addresses: Dr. Mahajan: Robert Wood Johnson Clinical Scholars Program, 911 Broxton Avenue, Suite 314, Los Angeles, CA 90024.Dr. Brook: The RAND Corporation, 1700 Main Street, Santa Monica, CA 90407. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCancer Screening before and after Switching to a High-Deductible Health Plan J. Frank Wharam , Alison A. Galbraith , Ken P. Kleinman , Stephen B. Soumerai , Dennis Ross-Degnan , and Bruce E. Landon Is Patient Cost-Sharing the Best Way to Protect the Medical Commons? Robert H. Fletcher , James E. Sabin , and Joseph Dorsey Is Patient Cost-Sharing the Best Way to Protect the Medical Commons? Anish P. Mahajan and Robert H. Brook Metrics Cited byWork, Health, And Worker Well-Being: Roles And Opportunities For EmployersIs Patient Cost-Sharing the Best Way to Protect the Medical Commons?Robert H. Fletcher, MD, MSc, James E. Sabin, MD, and Joseph Dorsey, MD 6 May 2008Volume 148, Issue 9Page: 704-706KeywordsCancer screeningColonoscopyColorectal cancer screeningHealth careHealth care qualityHealth information technologyHealth insuranceMotivationOutpatients ePublished: 6 May 2008 Issue Published: 6 May 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...