Does Enrollment in High‐Deductible Health Plans Encourage Price Shopping?

Zhang, Xinke; Haviland, Amelia; Mehrotra, Ateev; Huckfeldt, Peter J.; Wagner, Zachary; Sood, Neeraj

doi:10.1111/1475-6773.12784

Cited by 21 publications

(17 citation statements)

References 26 publications

(35 reference statements)

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“…The experience of RBP is in contrast to that of high-deductible health plans and price transparency initiatives, which have been found to be largely ineffective at encouraging patients to choose lower-price providers. [15][16][17][18] These overall results are consistent with prior evaluations of RBP for imaging tests. 9 One notable difference is that we find a delay in patient response until the second year of implementation.…”

Section: Utilization Rate Pmpmsupporting

confidence: 84%

“…We find that in the second year of a national insurer's “off‐the‐shelf” RBP program for advanced imaging was associated with a 22 percentage point increase in patient likelihood of choosing a lower‐priced facility for imaging procedures, a 8 percent reduction in the average procedure price, and no impact on utilization. The experience of RBP is in contrast to that of high‐deductible health plans and price transparency initiatives, which have been found to be largely ineffective at encouraging patients to choose lower‐price providers …”

Section: Discussionmentioning

confidence: 94%

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Association of a national insurer's reference‐based pricing program and choice of imaging facility, spending, and utilization

Sinaiko

Mehrotra

2020

Health Services Research

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Objective To examine the association of a national insurer's reference‐based pricing (RBP), program for outpatient advanced imaging—a benefit design to encourage patients to choose lower‐price facilities. Data Source/Study Setting Administrative and medical claims data for three self‐insured employers that introduced RBP and a comparison group without RBP. Study Design Difference‐in‐difference comparison of pre‐RBP (2014) and post‐RBP (2015‐6) care between intervention and comparison groups. Data Collection/Extraction Method We identified 137 680 imaging procedures (4602 intervention group; 133 078 comparison group) in 2014‐2016. Principal Findings In the first post‐RBP year (2015), there was no change in choice of facility; by the second year, RBP‐exposed enrollees were 21.9 pp (95% CI: 18.5, 25.3) more likely to choose a lower‐priced facility and net prices were $101.05 (95% CI: −$130.65, −$71.46), a difference of 8.1 percent lower. RBP was associated with higher patient out‐of‐pocket spending in the first post‐RBP year ($31.82; 95% CI: $10.91, $52.73). There was no change in utilization, and higher‐priced providers did not lower prices in the postperiod. Net savings represented 0.3 percent of outpatient spending. Conclusions Reference‐based pricing for advanced imaging was associated with a shift to lower‐priced facilities, but net impact on outpatient spending was modest. Patients paid increased out‐of‐pocket costs, though the amount declined after the first year of the program.

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Section: Utilization Rate Pmpmsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 94%

Association of a national insurer's reference‐based pricing program and choice of imaging facility, spending, and utilization

Sinaiko

Mehrotra

2020

Health Services Research

Self Cite

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“…In fact, HDHP enrollees engaged in limited price shopping or cost inquiry (Kullgren et al, 2018;Sinaiko, Mehrotra, & Sood, 2016). There was only modest reduction in prices paid from price shopping after enrolling in HDHPs (Sood, Wagner, Huckfeldt, & Haviland, 2013;Zhang et al, 2017).…”

Section: Background and Previous Literaturementioning

confidence: 99%

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences

Chen

Page

2018

Med Care Res Rev

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High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.

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“…A more precisely identified study found evidence of lower prices for some services, including childbirth, in the 2 years after one large employer switched to an HDHP, though its generalizability may be limited due to the specificity of the setting 10 . Finally, recent work found modest decreases in office visit and imaging pricing for employees whose employers switched to an HDHP 26 …”

Section: Introductionmentioning

confidence: 99%

Do high‐deductible health plans affect price paid for childbirth?

Cliff¹

2021

Health Services Research

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Objective To test whether out‐of‐pocket costs and negotiated hospital prices for childbirth change after enrollment in high‐deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Data Sources Administrative medical claims data from 2010 to 2014 from three large commercial insurers with plans in all U.S. states provided by the Health Care Cost Institute (HCCI). Study Design I identify employer groups that switched from non‐HDHPs in 1 year to HDHPs in a subsequent year. I estimate enrollees' change in out‐of‐pocket costs and negotiated hospital prices for childbirth after HDHP switch, relative to a comparison group of employers that do not switch plans. I use a triple‐difference design to estimate price changes for enrollees in markets with more hospital choices. Finally, I re‐estimate models with hospital‐fixed effects. Data Collection From the HCCI sample, childbearing women enrolled in an employer‐sponsored plan with at least 10 people. Principal Findings Switching to an HDHP increases out‐of‐pocket cost $227 (p < 0.001; comparison group base $790) and has no meaningful effect on hospital‐negotiated prices (−$26, p = 0.756; comparison group base $5821). HDHP switch is associated with a marginally statistically significant price increase in markets with three or fewer hospitals ($343, p = 0.096; comparison group base $5806) and, relative to those markets, with a price decrease in markets with more than three hospitals (−$512; p = 0.028). Predicted prices decrease from $5702 to $5551 after HDHP switch in markets with more than three hospitals due primarily to lower prices conditional on using the same hospital. Conclusions Prices for childbirth in markets with more hospitals decrease after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non‐HDHPs. These results reinforce previous findings that HDHPs do not promote price shopping but suggest negotiated prices may be lower for HDHP enrollees.

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Does Enrollment in High‐Deductible Health Plans Encourage Price Shopping?

Abstract: High-deductible health plan enrollment may shift enrollees to lower cost providers, resulting in modest savings.

Cited by 21 publications

References 26 publications

Association of a national insurer's reference‐based pricing program and choice of imaging facility, spending, and utilization

Association of a national insurer's reference‐based pricing program and choice of imaging facility, spending, and utilization

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences

Do high‐deductible health plans affect price paid for childbirth?

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