Impact of High Deductible Health Plans on Continuous Buprenorphine Treatment for Opioid Use Disorder

Kennedy-Hendricks, Alene; Schilling, Cameron; Busch, Alisa B.; Stuart, Elizabeth A.; Huskamp, Haiden A.; Meiselbach, Mark K.; Barry, Colleen L.; Eisenberg, Matthew D.

doi:10.1007/s11606-021-07094-9

Cited by 9 publications

(12 citation statements)

References 42 publications

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“…Our unit of analysis is the person-year. Following methods used in prior research, 4,7 we estimated the change in the outcome among those whose employers switched from not offering an HDHP insurance option to offering an HDHP compared with a comparison group whose employers never offered an HDHP during the study period. We followed the Internal Revenue Service definition for an HDHP; it varied by year, but deductibles averaged $1232 over the study period for individual plans and $2427 for family plans 10 .…”

Section: Methodsmentioning

confidence: 99%

“…We used an intent-to-treat difference-in-differences approach to estimate the effect of offering an HDHP on the probability of experiencing a nonfatal opioid overdose among person-years with OUD. We also estimated an event-study model to account for dynamic marginal effects over time 4,7 . All models included the full set of covariates as listed, with standard errors clustered at the firm level.…”

Section: Methodsmentioning

confidence: 99%

“…We also estimated an event-study model to account for dynamic marginal effects over time. 4,7 All models included the full set of covariates as listed, with standard errors clustered at the firm level. Given the evolving understanding of the limitations of traditional differencein-differences models in circumstances in which treatment timing varies across groups, we also conducted a treatment effect decomposition.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…2 Changes to insurance benefit design, such as higher deductibles and more burdensome cost-sharing requirements, may influence OUD treatment and related outcomes by heightening the financial barriers to treatment. 4 The prevalence of high-deductible health plans (HDHPs) in the United States has been increasing over the last 2 decades as these plans have captured a growing portion of the employer-sponsored insurance market: enrollment increased from 4% in 2006 to 29% in 2022. 5 Prior research has found that employer offer of an HDHP is associated with a reduction in health care service utilization, including lower spending on pharmaceuticals.…”

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confidence: 99%

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High-deductible Health Plans and Nonfatal Opioid Overdose

et al. 2023

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Objectives: Opioid-related overdose is a public health emergency in the United States. Meanwhile, high-deductible health plans (HDHPs) have become more prevalent in the United States over the last 2 decades, raising concern about their potential for discouraging high-need populations, like those with opioid use disorder (OUD), from engaging in care that may mitigate the probability of overdose. This study assesses the impact of an employer offering an HDHP on nonfatal opioid overdose among commercially insured individuals with OUD in the United States. Research Design: We used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. We used an intent-to-treat, difference-in-differences regression framework to estimate the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. We also used an event-study model to account for dynamic time-varying treatment effects. Results: Across both comparison and treatment groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. Our primary model and robustness checks revealed no impact of HDHP offer on the probability of a nonfatal overdose. Conclusions: Our study suggests that HDHP offer was not associated with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD. However, given the strong evidence that medications for OUD (MOUD) can reduce the risk of overdose, research should explore which facets of insurance design may impact MOUD use.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

mentioning

confidence: 99%

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High-deductible Health Plans and Nonfatal Opioid Overdose

et al. 2023

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“…Given that care for mental health disorders and SUDs continues to be a pressing public health concern and the high out-of-pocket cost associated with treatment, 4 a deeper understanding of the complex effects of HDHPs on this population is crucial for informing policy and regulatory decisions.Three 2022 studies investigated the intent-totreat effect of offering HDHPs on the use of SUD treatment services. [5][6][7] Eisenberg et al 5 found a 7.7% reduction in ambulatory services and a 4.3% reduction in medication treatment-the services public health officials aim to encourage. Meiselbach et al 6 built on these findings and found that more than three-quarters of reduced spending attributed to an HDHP came at the expense of care from the family member with an SUD.…”

mentioning

confidence: 99%