title: Perspectives from deductible plan enrollees: plan knowledge and anticipated care-seeking changes.
abstract: BACKGROUND
  Consumer directed health care proposes that patients will engage as informed consumers of health care services by sharing in more of their medical costs, often through deductibles. We examined knowledge of deductible plan details among new enrollees, as well as anticipated care-seeking changes in response to the deductible.
  
  
  METHODS
  In a large integrated delivery system with a range of deductible-based health plans which varied in services included or exempted from deductible, we conducted a mixed-method, cross-sectional telephone interview study.
  
  
  RESULTS
  Among 458 adults newly enrolled in a deductible plan (71% response rate), 51% knew they had a deductible, 26% knew the deductible amount, and 6% knew which medical services were included or exempted from their deductible. After adjusting for respondent characteristics, those with more deductible-applicable services and those with lower self-reported health status were significantly more likely to know they had a deductible. Among those who knew of their deductible, half anticipated that it would cause them to delay or avoid medical care, including avoiding doctor's office visits and medical tests, even services that they believed were medically necessary. Many expressed concern about their costs, anticipating the inability to afford care and expressing the desire to change plans.
  
  
  CONCLUSIONS
  Early in their experience with a deductible, patients had limited awareness of the deductible and little knowledge of the details. Many who knew of the deductible reported that it would cause them to delay or avoid seeking care and were concerned about their healthcare costs.
authors.affiliation: Division of Research, Center for Health Policy Studies, Oakland, California 94612, USA. mary.e.reed@kp.org
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Nancy
authors.initials: N
authors.lastname: Benedetti
authors.forename: Richard
authors.initials: R
authors.lastname: Brand
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D002140:California; D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance; D019033:Delivery of Health Care, Integrated; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations; D006801:Humans; D019458:Insurance Coverage; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care