High-deductible health plans: in the news and on the minds of researchers. Before us, two studies, one from UnitedHealth Group, the other from the Commonwealth Fund and the Baruch College School of Public Affairs at City University of New York.The latter, published in the July-August issue of Health Affairs, wants everyone to curb his enthusiasm about high-deductible plans paired with health savings accounts because they do not really reduce out-of-pocket costs for the consumers with the greatest health expenditures and therefore won't cut spending overall.

"Health care spending is highly concentrated [in] a small group of people who have very high medical costs," says the study's coauthor, Dahlia Remler, PhD. "This study shows that a high-deductible HSA would have no effect on this spending, leaving a negligible impact on health care costs."

Meanwhile, UnitedHealth's study says that because high-deductible health plans encourage use of preventive services, they do drive down costs — at least for employers. The studies are similar only insofar as they deal with the same subject. The conclusions are not mutually exclusive.

The Health Affairs study, according to Remler, makes the case that "the consumers with the big medical expenditures, who make up the bulk of the total expenditures, will not in fact have more 'skin in the game'. Only those in the middle will have more 'skin in the game.' Moreover, consumers already have some skin in the game, since managed care plans already have substantial cost-sharing."

The Commonwealth/Baruch study states: "Thus, we find that current HSA/high-deductible plans fall short of the accompanying rhetoric."

The UnitedHealth Group study places an emphasis on prevention, and so holds out hope that the high-deductible plans will shrink the cost pie, and not just change the size of the slices.

UnitedHealth's study tracks 55,000 employees from 2003 to 2005. Those workers in high-deductible plans are more likely to visit primary care physicians regularly for no-cost check-ups than those who are in traditonal plans. Costs to employers for employees who are enrolled in high-deductible plans deceased by 3 percent to 5 percent between 2003 and 2005, according to UnitedHealth. Costs for employers whose workers stayed in traditional plans rose by 8 percent to 10 percent during the same period.

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