Studies dating to the 1970s have consistently shown that when consumers must spend a big chunk of their own money on their care, they can cut back by as much as 15 percent. That slowdown happens fast, dropping like a health-care guillotine.
The question researchers still are weighing, though, is what consumers slice off. Do they stop filling name-brand prescriptions when equally effective generics are available? Or do they avoid critical care, by staying home instead of heading to the hospital?
Stephen Parente, a University of Minnesota economist who is working closely with congressional Republicans to build whatever replaces the Affordable Care Act, says that high-deductible plans must be tweaked. He would like to see a standard insurance policy carry at least a $5,000 individual deductible but provide exceptions for care for people with chronic conditions such as diabetes and asthma.
Some 117 million adults have such conditions, which become more expensive if left untreated. For them, self-rationing could compromise their health as well as further drive up spending.
Parente has teamed up with IHPI member Mark Fendrick, a health-policy professor at U-M, to develop a “version 2.0,” which would allow people dealing with chronic disease to access certain preventive services before they meet their deductible cap. Fendrick calls it a “high-value health plan.”