November 15, 2019

Your Money Adviser: When Health Deductibles Rise, Men Delay Emergency Care

Frank Wharam, a doctor and researcher at Harvard Medical School, says he often hears these words, “My wife made me come.”

That gender dynamic may provide fodder for stand-up comics, but it can have serious health implications, especially given the increasing use of high-deductible health insurance plans.

Men, it turns out, are more likely to delay treatment for serious conditions under high-deductible plans, in contrast to women, who tend to be more selective and cut back care for minor ailments only.

That’s according to a recent study led by Katy Kozhimannil, a researcher at the University of Minnesota’s school of public health. (Dr. Wharam was a co-author.)

Such plans generally have lower monthly premiums than traditional health plans but higher out-of-pocket costs — sometimes, $4,000 or $5,000 for a family, or even higher. About a third of workers now have such plans. And that number is likely to grow, since lower-cost plans on the new health care marketplaces created by the Affordable Care Act are likely to have relatively high deductibles.

Other studies have shown that low-income people also tend to put off care under such plans. But Ms. Kozhimannil says her study is the first to examine the different impact of such plans on men and women.

The study compared emergency room visits for about 12,000 people — roughly half men and half women — for a year before, and two years after, they were involuntarily switched by their employers to a high-deductible plan.

For the first year after the switch, men’s use of the E.R. dropped across the board, even for severe conditions, like irregular heartbeat. Women cut back too, but mostly for less threatening symptoms, like headache or sore throats.

“It’s concerning that men were not going to the E.R.” for ailments like kidney stones and irregular heartbeats, Ms. Kozhimannil said. “That’s an urgent situation that requires medical care.”

Unfortunately, men also ended up with more hospitalizations in subsequent years, suggesting that they may have let a serious condition go untreated.

So, what is behind this approach? Other findings have suggested that “masculinity beliefs” make it harder for men to ask for help, Ms. Kozhimannil said, so the added worry of spending more on health care may reinforce that tendency.

Jim Kiefert, who runs an “Us Too” prostate cancer support group in Olympia, Wash., said men often worry that spending on their own care may lead to economic hardship for their families. “That is a reality with men,” he said, adding that with a costly illness and a high deductible, “You can deplete your savings in a very short period of time.”

Here are some questions to consider, if you’re a man on a high-deductible plan — or that man’s spouse.

How can I use my high-deductible plan wisely?

Understand your benefits. Not all high-deductible plans are the same, and many cover preventive care outside of the deductible. Under the Affordable Care Act, all plans sold on the new marketplaces and many others must offer many preventive services free, like colorectal cancer screenings.

How should I decide when to seek treatment?

No one expects you to be a physician, but health plans increasingly offer sound online information that can help you learn about symptoms of serious situations, like a heart attack. “It’s very useful to know what your risk factors are,” said Ms. Kozhimannil said. Most health plans also have nurse advice lines that can offer guidance, too.

What if I need care, but I’m worried I can’t pay for it?

Talk about this with your doctor, who might not know what cost burden you’re facing when you make decisions about proposed treatments. “Say to your doctor, ‘I have a high-deductible plan. Is there a different way to do this?’ ” suggests Alison Galbraith, a doctor at the Harvard Pilgrim Healthcare Institute who has studied the plans.

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