Why do people in high deductible plans seek less preventive care?

A notable finding from a RAND study How Do Consumer-Directed Health Plans Affect Vulnerable Populations? is that members in high deductible plans receive fewer preventive services, such as mammography, after switching from traditional plans. That seems odd at first blush since preventive services aren't subject to the deductible.The authors suggest a couple of plausible reasons: members aren't familiar with the rules (so may think preventive services aren't covered) and some people may miss out on other appointments (that are subject to the deductible) where the preventive services might be suggested.Those are reasonable explanation, which demonstrate real limitations of these plans. But I can think of a couple of other reasons:

• Screening tests often lead to more expensive and invasive follow-up tests and treatments that may be subject to the deductible. So it's not just that members are wrongly worried about the cost of the screening test. They may be rightly concerned about what comes next
• High deductible plans get members thinking more keenly about the value of services received. They may apply their own judgments about the necessity of certain recommended preventive services. For example they may hew to the USPSTF's recommendations on mammograms rather than the wider use that most plans will pay for