Deductibles in Health Insurance, Beneficial or Detrimental: A Review Article

  • Iman MIRIAN Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
  • Mohammad Javad KABIR Health Management and Social Development Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gor-gan, Iran
  • Omid BARATI Education and Development Center, Hospital Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Khosro KESHAVARZ Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
  • Peivand BASTANI Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
Keywords:
Deductibles, Insurance, Health

Abstract

Background: One of the ways for cost-sharing in health system that has been taken into consideration in recent years in some developed countries is paying deductibles. In case of using deductibles, the insured people more carefully and accurately will use health care services, and potentially many unnecessary costs will be avoided.

Methods: To investigate the evidence of deductibles in health systems across the world, a literature review was conducted by searching the materials published in databases including ISI web of science, PubMed, Scopus and also Google scholar search engine from 2000 to 2017. Besides the related websites including WHO and the World Bank were searched. Inclusion criteria were studies carried out only in health insurance, English language, and the year of the study.

Results: The most important positive impacts of deductibles were decrease in utilization of different services, high profitability for the young and healthy people, lower health benefit claims by the insured people, and increase in financial profitability of health insurance organization. Besides, the most negative impacts increase in out of pocket burdens and also higher hospitalization over time.

Conclusion: Deductible plans have their own advantages and disadvantages for the insured and insurance organizations in terms of financial dimensions as well as utilization of health services, and explicitly none of these plans can be flawless. Given the increasing costs of health systems and the potential moral hazard of insured persons, it seems these systems sooner or later should inevitably move towards new cost-sharing plans, including deductibles.

 

References

1. Zweifel P, Manning WG (2000). Moral hazard and consumer incentives in healthcare. In: Hand-book of Health Economics. Vol. 1. Elsevier, Amsterdam, pp.: 409-459.
2. Soofi M, Bazyar M, Rashidian A (2012). Types of moral hazards and its effects on insurance marketing and health system. J Hosp, 11(3): 73-80.
3. Hajizade M (2008). Health economy. Jamenegar Publications. Iran [ in Persian]
4. Cattel D, van Kleef RC, van Vliet RCJA (2017). A method to simulate incentives for cost containment under various cost sharing designs: an application to a first-euro deductible and a doughnut hole. Eur J Health Econ, 18(8):987–1000.
5. Hoffman B (2006). Restraining the health care consumer: The history of deducti-bles and co-payments in U.S. health in-surance. Soc Sci Hist, 30(4): 507-528.
6. Reddy SR, Ross-Degnan D, Zaslavsky AM, et al (2014). Impact of a high-deductible health plan on outpatient visits and asso-ciated diagnostic tests. Med Care, 52(1): 86-92.
7. Committee on Child Health Financing (2014). High-deductible health plans. Pedi-atrics, 133(5): e1461-e1470.
8. van Winssen K, van Kleef R, van de Ven W (2013). Saving for health care: an interest-ing option to increase the attractiveness of voluntary deductibles. Health and Ageing Newsletter, 28.
9. Schellhorn M (2001). The effect of variable health insurance deductibles on the de-mand for physician visits. Health Econ, 10(5): 441-456.
10. Thonnes S (2015). Do deductibles reduce moral hazard in the German statutory health insurance? - Empirical evidence. Annual Conference 2015 (Muenster): Economic Development - Theory and Policy, Verein für Socialpolitik / German Economic Asso-ciation.
11. Law MR, Cheng L, Worthington H, et al (2017). Impact of income-based deducti-bles on drug use and health care utiliza-tion among older adults. CMAJ, 189(19): E690- E696.
12. Agarwal R, Mazurenko O, Menachemi N (2017). High-Deductible Health Plans Re-duce Health Care Cost And Utilization, Including Use Of Needed Preventive Services. Health Aff (Millwood), 36(10): 1762- 1768.
13. Van Etch TEM, Brabers AEM, van Dijk CE, et al (2017).Increased cost sharing and changes in noncompliance with spe-cialty referrals in The Netherlands. Health Policy, 121(2): 180- 188.
14. Zheng S, Ren ZJ, Heineke J, et al (2016). Reductions in Diagnostic Imaging with High Deductible Health Plans. Med Care, 54(2): 110-117.
15. Kozhimannil KB, Law MR, Blauer-Peterson C, et al (2013). The impact of high-deductible health plans on men and women: an analysis of emergency de-partment care. Med Care, 51(8): 639-645.
16. Wharam JW, Zhang F, Landon BE, et al (2013). Low-socioeconomic-status enrol-lees in high-deductible plans reduced high-severity emergency care. Health Aff (Millwood), 32(8): 1398-1406.
17. Gupta N, Polsky D (2015). High deductible health plans: does cost sharing stimulate increased consumer sophistication?. Health Expect, 18(3): 335-343.
18. Reiss SK, Ross-Degnan D, Zhang F, et al (2011). Effect of switching to a high-deductible health plan on use of chronic medications. Health Serv Res, 46(5): 1382- 1401.
19. Waters TM, Chang CF, Cecil WT, et al (2011). Impact of high deductible health plans on health care utilization and costs. Health Serv Res, 46(1): 155- 172.
20. Reed M, Fung V, Price M, et al (2009). High-Deductible Health Insurance Plans: Ef-forts to Sharpen a Blunt Instrument. Health Aff (Millwood), 28(4): 1145- 1154.
21. Wharam JF, Galbraith AA, Kleinman KP, et al (2008). Cancer screening before and af-ter switching to a high-deductible health plan. Ann Intern Med, 148(9): 647-655.
22. Putz C, Hagist C (2006). Optional deducti-bles in social health insurance systems: Findings from Germany. Eur J Health Econ, 7(4): 225-230.
23. van Kleef RC, van de Ven WPMM, van Vliet RCJA (2006). A voluntary deductible in social health insurance with risk equali-zation: "Community-rated or risk-rated premium rebate?” J Risk Insur, 73(3): 529-550.
24. van Vliet RC (2004). Deductibles and health care expenditures: empirical estimates of price sensitivity based on administrative data. Int J Health Care Finance Econ, 4(4): 283-305.
25. Segel JE, Kullgren JT (2017). Health insur-ance deductibles and their associations with out-of-pocket spending and afford-ability barriers among US adults with chronic conditions. JAMA Intern Med, 177(3): 433-436.
26. Abdus S, Selden TM, Keenan P (2016). The Financial Burdens of High-Deductible Plans. Health Aff (Millwood), 35(12): 2297-2301.
27. van Winssen KPM, van Kleef RC, van de Ven WPMM (2015). How profitable is a voluntary deductible in health insurance for the consumer?. Health Policy, 119(5): 688-695.
28. Galbraith AA, Ross-Degnan D, Soumerai SB, et al (2011). Nearly half of families in high-deductible health plans whose members have chronic conditions face substantial financial burden. Health Aff (Millwood), 30(2): 322- 331.
29. van Kleef RC, van de Ven WPMM, van Vliet RCJA (2009). Shifted deductibles for high risks: More effective in reducing moral hazard than traditional deductibles. Health Econ, 28(1): 198 -209.
30. Hemken N, Schusterschitz C, Thöni M (2012). Optional deductibles in GKV (statutory German health insurance): Do they also exert an effect in the medium term? J Public Health, 20(3): 219-226.
Published
2020-05-04
How to Cite
1.
MIRIAN I, KABIR MJ, BARATI O, KESHAVARZ K, BASTANI P. Deductibles in Health Insurance, Beneficial or Detrimental: A Review Article. Iran J Public Health. 49(5):851-859.
Section
Review Article(s)