Preventive Care Cut In CDHP Confusion

A majority of patients in consumer-directed health plans do not understand their coverage options and about 20 percent will skip preventive care because of cost, even though the services are free or very inexpensive.

Those are some of the findings in a study by Kaiser Permanente Northern California, which found that “consumers rarely understood that they did not have to pay the full price for preventive office visits and preventive tests. Those who mistakenly thought that their deductible applied to preventive care were significantly more likely than others to report avoiding preventive visits.”

The study — “In Consumer-Directed Health Plans, a Majority of Patients Were Unaware of Free or Low-Cost Preventive Care,” published in the Dec. 4, 2012 issue of Health Affairs — finds that 23.8 percent of respondents who thought that they had to pay for preventive services delayed or avoided care; only 7.8 percent of those who understood their coverage delayed or avoided care.

The services included an annual physical, cholesterol tests, diabetes screenings, mammograms, and colon cancer screenings. Not all of these were free, but the most costly was just $10.

The survey involved 456 Kaiser members younger than 65 who received their benefits through an employer with fewer than 50 workers in 2007. The deductibles were between $1,500 and $2,700 for individuals and $3,000 and $5,450 for families.

“Specifically, we asked participants to report whether the following types of services applied toward their health plan’s deductible: preventive office visits (for example, annual routine physicals), nonpreventive doctor’s office visits, preventive medical tests and screenings, and nonpreventive medical tests.”

The authors state that a major limitation of the study was its reliance on patient self-reporting rather than on utilization data collected in other ways. “However, it is important to note that knowledge of plan details is best assessed through patient self-reporting and that patient-initiated behavior, such as delays in care seeking, is challenging to identify directly in utilization data.”