Is not the goal, dammit! Better HEALTH is the goal!
I get seriously ticked when I read about studies like this:
Lower-income families in health plans with high deductibles are more likely than higher-income families to delay or skip medical care in order to avoid paying for it out-of-pocket, a new study found.
In fact, nearly one-half of all families, from a variety of income levels, who were enrolled in high-deductible health plans (HDHPs) reported they didn't receive a recommended medical service in the past six months because of the cost. By comparison, an earlier study found that 20% of the general U.S. population had reported delaying or missing care in the past year. [More]
The glaring omission in this research is that it did not attempt to answer the question: Did high-deductibles significantly alter the health outcomes for participants?
The presumption that more health care means better health is false. In fact, while we spend and consume vast amounts of GDP on health care our outcomes are slipping by comparison.
While little or no access to health care is terrifically damaging, blanket approaches to health care should be scrapped in favor of more targeted care.
Late in the article the above idea finally gets a ray of consideration.
In an accompanying editorial, Victor Grann, MD, MPH, of the Mailman School of Public Health at Columbia University in New York, said Kullgren and colleagues aren't the first ones to find that higher out-of-pocket costs result in people forgoing care. He pointed to a study that found doubling co-payments from $10 to $20 for a cholesterol drug may cause one-fifth of patients to stop taking it altogether.Now that makes sense.
Consumers cannot easily distinguish appropriate care from inappropriate care when deciding what to spend their money on, said Grann, who added that a "value-based insurance design" -- in which co-payments are low for medical interventions determined to be of high value, and higher for those determined to be a low value -- could be a better payment model than the current system, which places no judgments on the value of the services offered.