Navigating the Challenges of High-Deductible Health Plans: A National Survey


By Jeff Kullgren, MD, MPH 

More than one third of Americans with private health insurance face high out-of-pocket (OOP) expenditures for their health care because they are enrolled in high-deductible health plans (HDHPs).  An HDHP is a private health insurance plan with an in-network, annual deductible of at least $1,300 for an individual plan or at least $2,600 for a family plan, though in some cases the deductibles are substantially higher. It is anticipated that the continued rise in health insurance premiums combined with the requirement of the Patient Protection and Affordable Care Act (ACA) that most individuals carry health insurance coverage will fuel an acceleration of the recent steady growth of enrollment in HDHPs. Furthermore, many companies are shifting toward a full-replacement strategy in which only HDHPs are offered.

The growth of enrollment in HDHPs presents 2 significant challenges for patients who are enrolled in these plans.  First, consumers who face high cost-sharing often avoid getting services they actually need. For example, compared to individuals with traditional health insurance coverage, HDHP enrollees are more likely to forego high-priority office visits, long-term medications, and clinical preventive services in order to save money.9  These reductions in needed health care services are intensified among patients with chronic health conditions.

Second, prices for the same service often vary significantly across providers. Therefore, patients who pay OOP for much of their care might receive needed services but pay more than they needed to, which can amplify their financial burdens.

Despite these challenges, patients who are enrolled in HDHPs could use strategies to mitigate their OOP costs, such as budgeting for necessary care, accessing tools to select providers and venues of care based on their prices and quality, engaging their providers in shared decision making that considers costs, and negotiating prices for services. Though there are anecdotal reports of patients benefiting from these strategies, little is known about how common these behaviors are, what consumers perceive to be their effects, and where there may be promising opportunities to increase their use.

To answer these questions and determine how patients can best cope with the changing landscape of healthcare coverage, my colleagues and I at the University of Michigan will be conducting a national, online survey (funded by the Robert Wood Johnson Foundation) of Americans with HDHPs.  In order to ensure our data will be as useful as possible, we want the content of the survey to reflect the challenges and opportunities faced by actual patients in HDHPs.  To help us with this task, we are seeking a small number of HDHP enrollees to serve as paid Consumer Advisers on the project.  These consumers will advise us on how we should write the survey and, later, how we should publicize and disseminate the findings. (Consumer Advisers will be paid at a rate of $50/hour for 30-50 hours of work.  If you are interested in serving as a Consumer Adviser or know of other people who might be interested, please click here, email, or call 734-936-9278 for additional information.)

Given the financial and health burdens that many consumers are already facing—and the potential for some of these burdens to increase with the spread of HDHPs—we are eager to develop a better understanding of how consumers can be empowered to maximize the value of the healthcare services they receive.


Jeff Kullgren, MD, MPH is an Assistant Professor in the Department of Internal Medicine at the University of Michigan Medical School and a Research Scientist in the Center for Clinical Management Research at the Veterans Affairs Ann Arbor Health System. Dr. Kullgren’s research aims to improve patient decisions about preventive behaviors and utilization of health care services.


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