Meet U.S. health care, circa 2020

The high-deductible health plan (HDHP) will be commonplace in 2020 because many will not be able to afford anything else.

People with HDHPs almost invariably use less health care. They usually use self-diagnosis, followed by self-rationing. They generally cut back equally on unnecessary and necessary care. Patients tend to give less weight to the future state of their health than to present costs.

RAND Corp. conducted groundbreaking research in the 1970s that illustrates what happens with high consumer cost-sharing. The so-called Health Insurance Experiment randomly assigned 5,800 working-age adults to different levels of cost sharing, ranging from free to 95 percent. The results showed:

  • As the percentage paid by the patient rose, physician visits decreased.
  • The total amount of treatment received was unaffected once they began medical care, meaning consumers tended to lose control of costs.
  • Health outcomes were unaffected regardless of cost-sharing and medical usage.

Another, more recent RAND study showed that HDHP enrollees cut back on care regardless of their income or health.

A recent study found that families with HDHPs between $1,000 and $6,000 were 3-4 times more likely to delay or skip health care than those on traditional plans.

As Health Care in 2020 points out continuously, this will be our nation’s health-care landscape in a few short years, regardless of what happens to the health-reform law.