The Effect of High-Deductible Health Plans on Small Medical Practices

The Affordable Care Act (ACA) has brought a new cohort of insured into the medical system. It has also, however, caused an alteration in the insurance of many who already had coverage. As a way to pay for the increased cost of providing medical care to a larger population, the ACA (United States Dept. of Health n.p.) offers individuals the option of purchasing high-deductible health plans (HDHPs). The combination of newly insured and existing insured customers can lead to drawbacks for those patients and for small medical practices in particular.

A patient with limited resources who is on an HDHP may forgo needed medical treatments if he has to pay for them out-of-pocket due to a high deductible. These include not just routine medical care but also “…major health outcomes such as diabetes, cancer prevention strategies and survival, cardiovascular events, and mortality” (Wharam, Ross-Degnan, and Rosenthal 1481). It is an established truth in medicine that many big problems start as small ones that are easily treated if done so early. HDHPs may have the effect of many such small problems going untreated.

In turn, medical practices may lose customers who feel they cannot afford medical care for which they will have to pay partially or completely out-of-pocket. This could particularly affect small medical practices that are primary care providers as “Insurance plans shift a portion of the costs back to patients through deductibles, copayments, and coinsurance” (Ubel, Abernethy, and Zafar 1484). The effect could be a loss of patients and revenue as patients who have been shifted to HDHPs and the newly insured with HDHPs cannot or do not pay their bills.

Works Cited

Ubel, Peter A., Amy P. Abernethy, and S. Yousuf Zafar. “Full Disclosure--Out-of-Pocket Costs as Side Effects.” The New England Journal of Medicine, as cited in Perspective 17 Oct. 2013: 1484-1486. Print.

United States. Dept. of Public Health. “How the Marketplace Works.” Healthcare.gov. (2013). Web. 31 January 2014.

Wharam, J. Frank, Dennis Ross-Degnan, and Meredith B. Rosenthal. “The ACA and High-Deductible Insurance--Strategies for Sharpening a Blunt Instrument.” The New England Journal of Medicine, as cited in Perspective 17 Oct. 2013:1481-1484. Print.