The Impact of High-Deductible Health Plans: Broader Coverage and Depressed Outcomes

April 1, 2021
April 1, 2021

Healthcare providers must add how patients experience the financial side of healthcare to the many areas that require their focus and staff training, according to the HealthStream article, “Footing the Bill - Improving the Patient Financial Experience Is Increasingly Critical for Provider Profitability.” This blog post is the third in a series of excerpts from the article.

High-deductible plans expand coverage but depress outcomes.

Even as the Affordable Care Act has opened the doors to tens of thousands who had been uninsured due to cost or medical history, it has not done much to dent the cost of coverage for those who don’t qualify for subsidies—and has also led to a vast expansion in the number of high-deductible plans.

Many if not most silver and bronze plans, as laid out on the insurance exchanges run by state and federal governments, offer comprehensive coverage—but also feature deductibles that run into the thousands. Often that means patients delay coverage because they don’t have the funds to cover that initial out-of-pocket hit.

Delaying Care That Is Often Unaffordable

“If patients are putting off going to see the doctor because they can’t afford it, often they will wind up going to the emergency room,” says Bill Rector, a senior systems architect for healthcare IT systems provider, Allscripts. “A lot of times that turns out to be uncompensated billing for the hospital, plus those people are a lot sicker and require more expensive care than they would if they’d obtained care earlier.”

“Higher-deductible policies also have opened the risk pool a bit, because often those people who need the insurance coverage the most can afford it the least,” he continues. “If you have good health insurance but don’t have the money to cover the deductible, you’re not going to utilize that care. It’s like buying a car that has to have premium gas and you can only afford regular. You’re probably not going to drive it.”

The profusion of higher-deductible plans also means more self-pay money has entered the healthcare-provider revenue stream, since it jumps ahead of insurance reimbursements. Often those funds are far harder to collect and may have a higher default rate.

Anxiety is Common When It Comes to Healthcare Consumer Finance

No consumer enjoys paying bills—particularly high ones—so the challenge for healthcare providers is very real. This article looks more closely at the following reasons causing patients, their pocketbooks, and many healthcare organizations, some anxiety:

  • Healthcare is expensive.
  • Healthcare Costs Generate Patient Anxiety
  • Providing high-quality healthcare means delivering on many components.
  • Premiums continue to rise, and consumers continue to demand coverage.
  • Healthcare pricing remains a veiled mystery.
  • Patients are avoiding care, which drives up costs and depresses outcomes.
  • Providers think they are powerless in this situation.


Download the full article here.