Running Head: HIGH DEDUCTIBLE HEALTH PLANS

High Deductible Health Plans:

Positive and Negative Aspects
Kelly Erazo
National University

HIGH DEDUCTIBLE HEALTH PLANS

Introduction-HDHP
A high deductible health plan (HDHP) refers to a plan in which the patient must pay a high
deductible, or out-of-pocket cost, before the health insurance plan covers the remaining balance
of the cost, if any, for medical services rendered. Additionally, the benefit of the HDHP is that
the patient pays a very low monthly premium for their insurance. Typically, a patient can pay a
deductible of at least $1,100 per individual and $2,200 per family before the insurance covers
any service costs (Kullgren, Volpp, & Polsky, 2013). For some, this health plan is an affordable
way to have health insurance without paying high premiums, while for others, HDHPs may
result in a financial hardship. Either way, HDHPs have experienced a rapid growth over the past
several years (Wharam et al., 2012). HDHPs, like most other health plans, are intended to benefit
a certain section of the population, yet they negatively affect other sections of the population
while continuing to grow throughout the health care financial system.
Positive Aspects of HDHPs
According to Kullgren et al. (2013), HDHPs favor the healthy individuals who engage in healthy
behaviors. As mentioned before, HDHPs have high deductibles but low premiums, making them
more affordable for more people. Healthy people engaged in healthy behaviors do not need many
medical services per year, and therefore do not need to worry about the high deductible until an
emergency medical need presents itself, making HDHPs an excellent choice for them.
Additionally, HDHPs cause an individual to behave first as a consumer and second as a patient.
Mulvany (2014) explains that individuals who are seeking an HDHP will act as a consumer by
researching the prices of the plans first, rather than the type of care or the quality included in the
plan. Interest in price information over the type of care or its quality is growing faster among
HDHP enrollees than among traditional health plan enrollees (Mulvany, 2014). This consumer-

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behavior gives the healthy individual more control over his or her choice of health plans, as well
as his or her expenditures.
Negative Aspects of HDHPs
Although HDHPs are a great option for healthy individuals, people with chronic conditions
endure the negative aspects of the plans. Galbraith et al. (2012) conducted a study with the
objective of evaluating whether HDHPs were associated with higher rates of delayed or forgone
care due to cost, or DFCC, for adults and children in families with chronic conditions, compared
with traditional plans. Their study concluded that both adults and children were more likely to
experience DFCC in families with chronic conditions in HDHPs compared to traditional plans
(Galbraith et al., 2012). People with chronic conditions were less likely to seek medical attention
due to the high deductibles which could greatly unbalance their economic situation. Additionally,
people with chronic conditions and low-incomes were even more likely to increase their DFCC
risk (Galbraith et al., 2012). Gengler (2014) mentions that there is research that has found that
high deductibles discourage emergency room visits for minor ailments like a sore throat. HDHPs
therefore increase the fear in individuals with chronic conditions and/or low-incomes for
expensive or unaffordable medical services that may lead to a financial hardship.
Conclusion/ Personal Perspective on HDHPs
HDHPs are growing in popularity because of the low premiums that they offer, which make
health insurance more affordable for a wider section of the population. However, those with
chronic conditions, low-incomes, or both, can be negatively affected by the high deductibles that
HDHPs include. HDHPs offer healthy individuals an affordable insurance plan that serves as a
safety net for only extreme situations that need medical attention. By engaging in healthy
behaviors, individuals find ways to avoid using expensive medical care. Conversely, individuals

HIGH DEDUCTIBLE HEALTH PLANS

who may need frequent medical attention due to chronic conditions do not benefit from HDHPs.
Not only would the high costs of medical care affect their income, but also the lack or delay of
medical attention would affect their health, possibly causing the chronic condition to worsen.
Based on this discussion, HDHPs seem to benefit the majority of the population by allowing
them to afford health insurance, have more control over their choice of plans, and feel a sense of
security when it comes to their health expenses. However, HDHPs have the potential to reduce
the number of individuals negatively affected after some modifications have been done. One
suggestion for modification would be to offer options for high deductibles that take into
consideration various factors such as income, health status, number of illnesses, family size,
while comparing these factors among the community in order to provide affordable deductibles.
It is possible that a similar suggestion may already exist, but improvements and extensions can
occur to aid HDHPs.

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References

Galbraith A, Soumerai S, Ross-Degnan D, Rosenthal M, Gay C, Lieu T. Delayed and Forgone

Care for Families with Chronic Conditions in High-Deductible Health Plans. JGIM:
Journal Of General Internal Medicine [serial online]. September 2012;27(9):1105-1111.
Available from: Academic Search Premier, Ipswich, MA. Accessed September 22, 2014.
Gengler, A. (2014). High Deductibles Create Real Pain for Thrifty Men. Money, 43(5), 20.
Kullgren, J. T., Volpp, K. G., & Polsky, D. (2013). Are the Healthy Behaviors of US HighDeductible Health Plan Enrollees Driven by People Who Chose These Plans? Smoking as
a Case Study. Plos ONE, 8(2), 1-6. doi:10.1371/journal.pone.0056154
Mulvany, C. (2014). the march to consumerism: the evolution from patient to active shopper
continues. Hfm (Healthcare Financial Management), 68(2), 36-38.
Wharam, J., Graves, A., Zhang, F., Soumerai, S., Ross-Degnan, D., & Landon, B. (2012). Twoyear trends in cancer screening among low socioeconomic status women in an HMObased high-deductible health plan. Journal Of General Internal Medicine, 27(9), 11121119. doi:10.1007/s11606-012-2057-x