Do High-Deductible Health Plans Threaten Quality of Care?

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Abstract
Employers struggling with rising health care costs are implementing their strategy for the post–managed-care era — a shift of costs and responsibility to the consumer. As Robinson describes in this issue of the Journal (pages 1199–1202), this shift is likely to be accelerated by the spread of health savings accounts, which are expected to encourage as many as 25 percent of privately insured Americans to enroll in “high-deductible health plans” by the end of the decade. With these insurance products, patients bear a substantial portion of their health care costs ($1,000 or more per year for individuals). Advocates of these products hope that they will do more than shift part of the increase in health care costs to the patient: they believe that financial incentives will turn patients into “activated consumers” who exert pressure on health care providers to improve the efficiency and quality of care.