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High-deductible health plans have become more common in recent years, and continue to grow rapidly. But according to the American Academy of Pediatrics (AAP), these plans can be a bad choice for children. In a new policy statement, “High-Deductible Health Plans,” in the May 2014 Pediatrics (published online April 28), the AAP explains why these plans, similar to many of the “bronze” plans offered in the health insurance marketplace, are particularly inappropriate for children.

According to the policy statement, high-deductible health plans decrease health care expenditures, but at the cost of quality of care, continuity of care, and accessibility to care, especially for patients of modest means. By deterring access to primary care, these plans also hamper patient-centered medical homes, which are important components of efficient and high-quality health systems. Families with small children tend to be high users of primary care services, and financially struggling parents with a high-deductible health plan may delay needed care for a sick child if faced with a high out-of-pocket expense. Because the ill pay more than the healthy under these plans, children with special health care needs will experience higher costs under a high-deductible plan than with conventional insurance.

The AAP cautions that if high-deductible health plans are offered, they should be accompanied by health savings accounts funded by the employer at high levels. Insurance companies issuing these policies should devise procedures to enable medical offices and patients to understand the costs and provisions of such plans. The AAP advocates for research into the effects of high-deductible health plans on children. The AAP also recommends that health policy leaders and insurance companies press for savings in medical sectors where high prices prevail, where costs might be more easily abated without compromising quality, continuity, and access.

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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