High-deductible health plans

Budd N. Shenkin, Thomas F. Long, Suzanne Kathleen Berman, Mary L. Brandt, Mark Helm, Mark Hudak, Jonathan Price, Andrew D. Racine, Iris Grace Snider, Patience Haydock White, Molly Droge, Earnestine Willis, Edward P. Zimmerman

Research output: Contribution to journalArticle

6 Scopus citations


High-deductible health plans (HDHPs) are insurance policies with higher deductibles than conventional plans. The Medicare Prescription Drug Improvement and Modernization Act of 2003 linked many HDHPs with tax-advantaged spending accounts. The 2010 Patient Protection and Affordable Care Act continues to provide for HDHPs in its lowerlevel plans on the health insurance marketplace and provides for them in employer-offered plans. HDHPs decrease the premium cost of insurance policies for purchasers and shift the risk of further payments to the individual subscriber. HDHPs reduce utilization and total medical costs, at least in the short term. Because HDHPs require out-of-pocket payment in the initial stages of care, primary care and other outpatient services as well as elective procedures are the services most affected, whereas higher-cost services in the health care system, incurred after the deductible is met, are unaffected. HDHPs promote adverse selection because healthier and wealthier patients tend to opt out of conventional plans in favor of HDHPs. Because the ill pay more than the healthy under HDHPs, families with children with special health care needs bear an increased cost burden in this model. HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care. This policy statement provides background information on HDHPs, discusses the implications for families and pediatric care providers, and suggests courses of action.

Original languageEnglish (US)
Pages (from-to)e1461-e1470
Issue number5
StatePublished - May 2014
Externally publishedYes


  • Health reimbursement arrangement
  • Health savings account
  • High-deductible health plan
  • Patient Protection and Affordable Care Act
  • Patient-centered medical home

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'High-deductible health plans'. Together they form a unique fingerprint.

  • Cite this

    Shenkin, B. N., Long, T. F., Berman, S. K., Brandt, M. L., Helm, M., Hudak, M., Price, J., Racine, A. D., Snider, I. G., White, P. H., Droge, M., Willis, E., & Zimmerman, E. P. (2014). High-deductible health plans. Pediatrics, 133(5), e1461-e1470. https://doi.org/10.1542/peds.2014-0555