Committee on Child Health Financing
Pediatrics (Official Journal of the American Academy of Pediatrics)
March 2007
Policy Statement
Abstract
Consumer-driven health care is the most noteworthy development in health insurance since the widespread adoption of health maintenance organizations and preferred provider organizations in the 1980s. The most common consumer-driven health plan is the high-deductible health plan, which is essentially a catastrophic health insurance plan, often linked with tax-advantaged spending accounts, with very high deductibles, fewer benefits, and higher cost-sharing than conventional health maintenance organization or preferred provider organization plans. The financial risks are significant under high-deductible health plans, especially for low- to moderate-income families and for families whose children have special health care needs. Of concern for pediatricians are the potential quality risks that are predictable in high-deductible health plans, in which families are likely to delay or avoid seeking care, especially preventive care (if it is not exempted from the deductible), when they are faced with paying for care before the deductible is met. This policy statement provides background information on the most common consumer-driven health plan model, discusses the implications for pediatricians and families, and offers recommendations pertaining to health plan product design, education, practice administration, and research.
http://pediatrics.aappublications.org/cgi/content/full/119/3/622
Comment:
By Don McCanne, MD
The American Academy of Pediatrics is to be commended for stressing the importance of protecting preventive services from the negative impact of high-deductible health plans.
Unfortunately, many of their specific recommendations are self-serving for pediatricians (full up-front payment of billed charges, debit cards, payment for telephone consultations, etc.). Conspicuously absent were specific recommendations to prevent the negative impact of high-deductibles on acute and chronic care. It is not as if they didn’t understand this in that a specific recommendation under practice management was to “prepare for greater administration/collection burdens and bad debts.”
High-deductible health plans are bad for children’s health. The Academy should be condemning these plans and supporting comprehensive solutions that would enhance the health of the nation’s children. A national health insurance program would not only cover preventive services, but it would also remove financial barriers to beneficial acute and chronic health care services.
It’s time for physicians to quit whining about how badly they’re being treated by our dysfunctional system, and start advocating for change that will meet the needs of their patients. A practice environment that works well for patients is one that works well for physicians as well.
