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Open Access Research article

Perspectives from deductible plan enrollees: plan knowledge and anticipated care-seeking changes

Mary Reed1*, Nancy Benedetti1, Richard Brand2, Joseph P Newhouse345 and John Hsu136

Author Affiliations

1 Center for Health Policy Studies, Division of Research, 2000 Broadway, Oakland, California, 94612, USA

2 Department of Epidemiology and Biostatistics, University of California at San Francisco, 185 Berry Street, San Francisco, California, 94107, USA

3 Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, 02115, USA

4 Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, 02115, USA

5 Harvard Kennedy School of Government, 79 John F Kennedy Street, Cambridge, Massachusetts, 02138, USA

6 James J Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Boston, Massachusetts, 02114, USA

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BMC Health Services Research 2009, 9:244  doi:10.1186/1472-6963-9-244

Published: 29 December 2009



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.


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.


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.


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.