The American Academy of Pediatrics discourages the use of high-deductible health plans for children, calling the plans inappropriate for young patients and a threat to primary care services. Such plans have a disproportionate impact on poor families and children with special needs who pay more than the healthy under this model, according to a new policy published April 28 in Pediatrics.
High-deductible health plans "put more pressure on those who are ‘just making it,’ " Dr. Budd Norman Shenkin, a member of the AAP Committee on Child Health Financing, said in an interview. "A patient on Medicaid can see a doctor without cost; a patient of a prosperous family can afford the deductible without a problem; the working-class family will need to decide how dangerous it might be to let the child go without medical care. A medical decision becomes an economic decision – ‘Is he $150 sick?’ "
High-deductible health plans (HDHPs) have become more common as employers search for a way to reduce the cost of providing health insurance. A 2013 Kaiser Family Foundation report found that about 20% of employees at small companies were covered by HDHP plans, compared with 4% in 2006. Just over 40% of employees at large companies in 2013 were covered by HDHP plans in 2013, as opposed to 8% in 2006.
The AAP policy notes that while high-deductible health plans decrease health care expenditures, they do so at the cost of quality of care, continuity of care, and accessibility to care, especially for patients of modest means (Pediatrics 2014 [doi:10.1542/peds.2014-0555]).
By deterring primary care access, HDHPs also inhibit patient-centered medical homes, a critical component of efficient and high-quality health systems, the policy said.
Families insured by HDHPs may choose to take their children to a retail-based clinic for care, rather than the child’s pediatrician to save cost, potentially disrupting proper medical intervention by a pediatrician and compromising quality of care, Dr. Thomas F. Long, chair of the AAP Committee on Child Health Financing, said in an interview.
Families should not have to choose between seeking health care for their children and other essentials such as food, gas, or living expenses, Dr. Long said. Those with the plans also may be slower to pay their out-of-pocket expenses for doctor visits, leading to financial struggles for pediatricians, adds Dr. Long.
"If you’re having trouble collecting that high deductible, that makes it more difficult to run a pediatric office," he said. It affects a "pediatrician’s ability to keep his office open and keep his services available to the community. If those dollars are not coming in because of high deductibles, the sustainability [of a practice] is in jeopardy."
The AAP policy recommends that health savings accounts (HSAs) be included with HDHPs and funded by employers at high levels. Health insurers issuing high-deductible plans should also design procedures that help medical offices and patients better understand the costs and provisions of these plans. The AAP policy calls on the federal government to consider banning high-deductible health plans for those under 18 years. If HDHPs continue to include children, the AAP would like to see insurers define children with certain diagnoses as those with "special needs," using the Department of Health & Human Services’s Maternal and Child Health Bureau’s definition, thus eliminating the burden of a deductible for such children.