Dr Niteesh Choudhry Discusses the Pros and Cons of HDHPs

High-deductible health plans have a role to play, but it's important that they aren't used in such a way as to create a disincentive of the use of a consumer's benefits, said Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Transcript (slightly modified)

How can we ensure that patients in high-deductible health plans still utilize high-value services?

I think there are a couple things to consider. So these high-deductible health plans (HDHPs) no doubt have a role to play; the economic realities of our situation and spending and costs and the needs of employers are not things that people are making up. And so, in principle, HDHPs may actually lead to lots of good things in healthcare.

The problem, at least in the short term, are those patients who are most at risk and are therefore making choices that may be not in their interest. And so we somehow need to save either those services or those individuals, and find a way to actually provide them with benefits that would not create a disincentive for their use. So, for example, if we were to link HDHPs with value-based insurance design is an example where we sort of identify high-value services like prescription drugs or certain individuals or certain procedures, and we say, “Okay, those things should have no copayments or no deductibles, or lower copayments or deductibles than the standard benefit.”

Right now HDHPs often have $0 coverage for vaccination, which is probably a valuable service for most people, but also for primary care visits and, as you know, there’s lots of debate about the value of primary care today. As a general internist you know I can appreciate the fact that it’s not always clear that what we do in a well visit leads to better outcomes, and so that’s not actually value-based insurance design.

Instead what we should say is $0 dollar copayments for those services that we know to be of value.