Forcing vulnerable patients to make financial decisions under high-deductible plans takes clinical decisions out of physicians’ hands.
It sounds so innocuous and even empowering, this “consumer-directed-healthcare” idea that’s circling around.
What a nice way of saying that thousands more of the first dollars of the cost of care are being shifted to patients to keep rising premiums from crushing their employers and themselves. And that magical health savings account that further dilutes take-home pay is there for them to cover the copays and deductibles like it’s not real money.
Until something bad happens and it runs out, that is, and the whole scheme contributes mightily to the likelihood of that happening.
The RAND Corporation studied the impact of consumer-directed healthcare (CDHC) behaviors last year and determined that CDHC could save about $57 billion per year if enrollment grew to 50 percent of the non-elderly population. Participating patients were found to have fewer visits to specialists, fewer hospitalizations, and lower use of brand-name drugs - all of which lowered their costs.
Researchers also found that patients elected between three and five percent fewer screenings for things like cancer during the study period. Just staying there for a moment, the 50 percent marker is about 85 million people. Taking the median four percent passing on cancer screenings alone is 3.4 million fewer screenings. Just a two percent increase in advanced cancer missed because screenings were declined by patients is 68,000 more cases at an average of $100,000 per case, or $68 billion in added costs. Annually.
The bad news for physicians and other healthcare providers who are being shifted to pay-for-performance, shared-savings, and risk-reimbursement programs is that they will eat those added costs down the road. Down the road, by the way, is everyone being shifted to those programs. Add a bunch of other missed screenings and the price tag for this policy becomes so high that even the federal government would blanch, and they should, because Medicare will be on the hook for much of that cost.
The RAND researchers noted that “Reduction in preventive services might have unintended negative consequences to long-term health and costs if diseases are not detected early.” Looking through the literature, this observation was duly noted, and, curiously, no one, including RAND, thought to expand that finding to its logical conclusion and to monetize it.
RAND should, and soon. The organization has the data and hyping the immediate savings without calculating the consequences with equal diligence is disingenuous, and potentially disastrous to people, providers, and our economy.