High deductibles clash with care coordination and primary care

High deductibles add to consumers' financial stress and dissuade some patients from getting needed medical care. That is not only worrisome, but it could also block attempts to reform U.S. healthcare, health-policy experts warn in the latest New England Journal of Medicine.

High deductibles—an increasingly common feature of private health plans—require patients to spend hundreds, or sometimes thousands of dollars to see doctors, fill prescriptions or get diagnostic tests before their insurance plan will begin to pick up the bill. But experts and advocates have long argued that deductibles can be a nondiscriminatory way to get patients to stop and consider the price and necessity of the medical care they seek. 

As private health plans introduce new financial incentives for doctors and hospitals to pay closer attention to disease prevention, primary care and chronic-disease management, the proliferation of high-deductible health plans is creating a new problem, wrote Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice, and Peter Lee, executive director of California's health insurance exchange, in the journal. As systems invest anew in primary care and care coordination, patients have a new incentive to avoid their doctors.