Study: High-Deductible Plans Could Deter Sick From Seeking Care

High-deductible health plans made patients more likely to forgo care, but they also did not lower prices as experts had anticipated, according to a National Bureau of Economic Research study, Vox reports.

Study Details

For the study, economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel and Jonathan Kolstad looked at a company that shifted upwards of 75,000 employees and their dependents from a no-deductible health plan to one with a $3,750 deductible in 2013. The unnamed company also gave workers a $3,750 subsidy for a health savings account and provided them with price comparison tools for tests, physician visits and other services.

Study Findings

The study found little evidence that employees used the price comparison tools. Instead, the researchers found that "spending reductions [were] entirely due to outright reductions in quantity," instead of patients selecting lower-priced procedures.

According to the study, average per-patient spending declined from about $5,200 in 2012 to nearly $4,450 in 2013. Between 2012 and 2014, the study found that spending on:

• Emergency department visits decreased by 25%;
• Physician office visits decreased by 18%; and
• Mental health services decreased by 6%.

According to the study, employees did receive less "potentially wasteful care," such as imaging services. However, the workers also received less "potentially valuable care," such as preventive visits.

In addition, employees who reduced their use of care the most before reaching their deductibles were the sickest workers, even though they were also the most likely to continue using services after their deductibles were reached. Once such workers did exceed their deductibles, their use of medical services increased, the study found.

According to Vox, the results contrast with widely held views. Many health economists have long believed that higher deductibles would drive down health spending by encouraging patients to not only seek fewer services, but also be more active shoppers -- by researching and selecting lower-price procedures -- which in turn could push some providers to lower their prices.

Comments

Kolstad said it is unclear why sicker patients would curb their use of health services when they were likely to hit their deductibles, especially considering the subsidies they received for HSAs. Kolstad speculated that the patients could have trouble estimating their annual health care costs.

In addition, Kolstad said while the study only analyzed a two-year period, the trend of sicker patients forgoing care could potentially increase health care costs in the long term and reduce worker productivity. Kolstad suggested that more research is needed to evaluate the issue (Kliff, Vox, 10/14).