American Academy of Pediatrics Frowns Upon "Consumer Driven" Health Plans

In the on-going debate about healthcare reform and providing affordable health insurance to all Americans, much has been said about "Consumer Driven" health insurance as a way to minimize the costs of health insurance. The introduction of such a private insurance model is being tested in several states, and it is still in its infancy, so whether consumer driven insurance truly becomes a viable alternative to the current employer based system of medical benefits remains to be seen. But right now most consumer driven policies are based on high deductible plans, and many in the medical community object to such plans because they fear that the high deductibles -which mean that patients have to cover much more of the costs for there basic care before the policies kick in - are keeping patients from preventive care and routine doctor visits. The most recent organization to voice such an opinion was the American Academy Of Pediatrics.

The group, which represents 600,000 pediatricians nationwide, wrote in a statement in the March issue of Pediatrics that such consumer directed health plans might cause families to forego routine doctor visits for their children or preventive medicine treatments such as immunizations until they have met their deductibles and their health insurance pays for the services. While this makes health insurance more affordable for families without insurance, it can also have the opposite effect of its intention. Such health plans may actually increase overall healthcare costs nationwide, because if consumers delay preventive treatment, they may wind up needing more expensive treatments later on. Even if health insurance pays for the more expensive procedure, in the long run we all wind up footing that bill.

The report comes on the heels of many more corporations offering the high-deductible plans to their employees rather then dropping health insurance benefits altogether. Since 2005 some 30% of large companies polled offered the plans as a cost saving measure, instead of eliminating coverage. In 2004 the same respondents numbered only 7%. This is a major increase that has the Academy concerned, because under the current regulations insurance companies that provide the high deductible health plans are entitled to exempt fees paid for preventive care from going toward achieving the deductible amount, and a study found that more than 30% of those issuing the policies do so. The Academy recommends that changes in legislation are made that removes this exemption, and requires that the high-deductible plans include the cost of preventive care in the deductible amount.

Other critics of these high-deductible health plans have found that patients with them will also tend to fail to fill prescriptions when needed, and are less likely to pursue recommended follow up care with their physicians. Still most agree that having any kind of medical insurance is better then nothing. But for consumer driven health plans to work as they are intended, consumers need to be educated more about how to use a high-deductible plan effectively, maintain funds in an Health Savings Account, and otherwise reduce the costs of their healthcare through wellness and lifestyle programs.