High-Deductible Health Plans Don’t Actually Increase Consumerism


High-deductible health plans (HDHPs) are associated with lower health care spending, but not because consumers are shopping around for healthcare, according to a study published in the Journal of the American Medical Assn. (JAMA). Health insurance claims data indicates that these savings are due primarily to decreased use of care, and not because HDHP enrollees are switching to lower-cost providers. Enrollees in HDHPs are no more likely than those in traditional plans to consider switching their health care provider or comparing out-of-pocket cost among health care providers.

Researchers surveyed a nationally representative sample of insured adults from 18 to 64 who used medical care in the past year. They compared enrollees in HDHPs  with those in traditional plans on how much they shopped for care. The study found the following:

  • High-deductible health plan enrollment is higher among whites, those employed, those with more education, and those with higher incomes.
  • 60% of HDHP enrollees say there are large differences in prices and quality among health care providers.
  • 17% say that higher price physicians provide better care.
  • 71% say that out-of-pocket costs are important when choosing a doctor. These perceptions are not significantly different from those in traditional plans. HDHP enrollees are less likely to say that higher price facilities provide better care. They are more likely to say that out-of-pocket costs are important in choice of radiology facility.
  • 56% of HDHP enrollees say they would use additional sources of health care price information if available.

To encourage price shopping, consumers need more price information. Also, the market needs innovative approaches to get enrollees to take advantage of pricing information, according to researchers.

Are Patients with True Emergencies Being Discharged from the ER?

The American College of Emergency Physicians (ACEP) points to a growing practice of insurance carriers (including Medicaid) denying payment for so-called “non-emergency” visits to the ER. ACEP says that this practice is likely to discourage patients from seeking the appropriate care for true emergencies.

The small numbers of emergency patients who are discharged from the ER with “primary care treatable” diagnoses have the same symptoms as patients who have been determined to need immediate or emergency care, hospital admission, or surgery, according to a study to be published in the Journal of the American Medical Association (JAMA).

Lead study author Maria Raven, MD, MPH, FACEP said, “Two patients could come to the emergency department with the same symptoms; one could be diagnosed with a condition that is not that serious while another could be diagnosed with a life-threatening condition…There is no possible way to determine the outcome of the visit in advance, and our study has shown that it’s not good policy to do so after the fact. Insurance companies should not treat these two patients differently. Patients should never be burdened with the task of diagnosing themselves out of fear that their potential emergency isn’t covered by insurance.”


Although only 6.3% of emergency department visits were determined to have “primary care treatable” discharge diagnoses, the chief complaints for these visits were the same as those reported for 88.7% of all other emergency visits. A substantial portion of these visits required immediate emergency care or hospital admission. These findings suggest that these “primary care treatable” discharge diagnoses are unable to accurately identify non-emergency ER visits.

Dr. Raven said, “If a triage nurse were to redirect patients away from the ER based on non-emergency complaints, 93% of the redirected ER visits would not have had primary care-treatable diagnoses. The results call into question reimbursement policies that deny or limit payment based on discharge diagnosis. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visit the emergency department for urgent or more serious problems.” For more information, visithttp://www.acep.org

Hospital Readmissions: A Look At Pediatric Hospitals

Unintended hospital readmissions have become a key quality-of-care indicator. A study led by Boston Children’s Hospital looked at readmission rates at dedicated pediatric hospitals nationwide and found great variability. Findings appear in the January 23/30 issue of JAMA. Researchers say that the reasons for the varied readmission rates may include differences in hospital care, follow-up care outside of the hospital, as well as community and family factors that influence child health.

Some hospitals and their local health systems had very low readmission rates for diseases that tend to have much higher rates, says first author Jay Berry, MD, MPH, a pediatrician in the Complex Care Service at Boston Children’s Hospital. “We want to know whether there is something these hospitals and systems are doing to more effectively transition their children home.”

The study reveals the following:

• 6.5% of children had unplanned readmissions within 30 days of discharge and 39% them were readmitted within seven days. (In contrast, readmission rates at adult hospitals range from 20% to 25%.) Two-thirds of readmissions were for children with at least one chronic condition; Readmission rates were as high as 23% for certain medical conditions,
• The 30-day readmission rates varied among the 72 hospitals, ranging from 4.6% to 8.5%.
• Readmission rates were 6.9% for patients with public insurance, such as Medicaid, 5.9% for those with private insurance, and 4.5% for those with no insurance.
• Readmission rates ranged from 5.4% for children with one chronic condition to 17% for those with four or more.
• Ten conditions accounted for the highest readmission rates: anemia/neutropenia, ventricular shunt procedures, sickle-cell crisis, seizures, gastroenteritis, upper respiratory infection, pneumonia, appendectomy, bronchiolitis and asthma. These 10 conditions accounted for 28% of all readmissions. Their readmission rates were 17% to 66% higher in hospitals with higher-than-average readmission rates than in low-readmission hospitals.
• Readmission rates were higher for patients with longer hospital stays, from 4.6% for patients with a one- to two-day stay to 11.2% for patients with stays of seven days or longer.

“The variation…at different hospitals suggests that there is room to improve. The effort, though, will involve more than just hospitals. Community clinicians and organizations have a role to play as well. Parents also need support in being able to stay home with their recuperating children…There are some children with complicated medical needs who have really high readmission rates. Let’s figure out what’s going on and see if there is an opportunity to make their care transitions better,” says Berry. For more information, visit http://vectorblog.org.

Last Updated 07/21/2021

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