Health Affairs June 2013 vol.32 no.6 1126-1134
Consumer-Directed Health Plans Reduce The Long-Term Use Of Outpatient Physician Visits And Prescription Drugs
- Paul
Fronstin1,*,
- Martín
J. Sepúlveda2 and
- M.
Christopher Roebuck3
-
1Paul Fronstin (fronstin{at}ebri.org)
is a senior research associate at the Employee Benefit Research Institute, in
Washington, D.C.
-
2Martín J. Sepúlveda is an IBM Fellow and vice president
of health industries research for the IBM Corporation, in Somers,
New York.
-
3M. Christopher Roebuck is president of RxEconomics, a
health economics and policy consulting firm in Hunt Valley, Maryland.
Abstract
Consumer-directed health plans (CDHPs) are designed to make
employees more cost- and health-conscious by exposing them more
directly to the costs of their care, which should lower demand for care and,
in turn, control premium growth. These features have made
consumer-directed plans increasingly attractive to employers. We explored
effects of consumer-directed health plans on health care and
preventive care use, using data from two large employers—one that adopted a CDHP
in 2007 and another with no CDHP. Our study had mixed
results relative to expectations. After four years under the CDHP, there were
0.26 fewer physician office visits per enrollee per year and
0.85 fewer prescriptions filled, but there were 0.018 more emergency department
visits. Also, the likelihood of receiving recommended cancer
screenings was lower under the CDHP after one year and, even after recovering
somewhat, still lower than baseline at the studyfs conclusion.
If CDHPs succeed in getting people to make more cost-sensitive
decisions, plan sponsors will have to design plans to incentivize primary care
and prevention and educate members about what the plan
covers.
June 05, 2013 - Topic: Public Health
Workers Cut Health Visits After Switch to High-Deductible
Plan
U.S. workers made fewer visits to their physicians and pharmacies after their
employers moved them into a high-deductible health plan with a health savings
account, according to a study published this week in Health
Affairs, Modern Physician reports.
Study Details
For the study, a team of researchers -- Paul Fronstin, a senior researcher at
the Employee Benefit Research Institute; Martín Sepúlveda, vice president of
health industries research at IBM; and health policy and economics consultant M.
Christopher Roebuck -- compared medical and prescription billing data for two
employers between 2006 and 2010. One of the companies switched to HDHPs in
January 2007, while the other did not.
Study Findings
The study found:
- Routine screenings for cancer declined during the year after the insurance
plan switch, although screenings for breast, cervical and colorectal cancers
later rebounded;
- Emergency department visits increased during the third year after the
switch; and
- Hospital use remained consistent before and after the switch.
According to the researchers, their findings indicate that beneficiaries of
HDHPs might forgo preventive treatment because they are confused about the
plan's coverage. For example, rates for routine cancer screenings fell even
though the costs for the screenings were waived under the plans. Meanwhile, the
unexpected increase in ED visits might indicate a lack of adequate primary care,
particularly among patients with chronic conditions, the researchers said.
According to Modern Physician, the study's finding corroborates a 2011 RAND study,
which found that beneficiaries of consumer-directed plans tend to reduce their
use of both medically appropriate and inappropriate services because of the
potential increase in out-of-pocket costs.
The authors of the new study concluded that insurers must "design plans to
incentivize primary care and prevention and educate members about what the plan
covers" (Evans, Modern Physician, 6/4).
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