The role of plan choice in health care utilization of high‐deductible plan enrollees

Abstract

Objective:To study whether the negative association between enrollment in highdeductible plans and health care utilization is driven by reverse moral hazard or favorable selection, by examining adults with and without a choice of plans. Data Source: 2011-2016 Medical Expenditure Panel Survey Household Component data on nonelderly adults enrolled in employer-sponsored insurance. Study Design: Four types of plans were examined: high-deductible health plans (HDHPs), consumer-directed health plans (CDHPs), low-deductible health plans (LDHPs), and no-deductible health plans (NDHPs). Multivariate logistic regressions of various measures of health care utilization were conducted to estimate the differences in utilization across plan types among those who had a choice of plans and those who did not.Principal Findings: Among adults with a choice of plans, HDHP enrollees had lower levels of utilization compared with those of the NDHP enrollees for any ambulatory visit, any specialist visit, and most preventive services. Among adults without any choice of plans, the differences between HDHP enrollees and NDHP enrollees were not statistically significant. Conclusions:The differences between those with and without choice of plans in the relationship between HDHP enrollment and health care utilization might possibly be explained by favorable selection. K E Y W O R D Shealth care utilization, high deductible, plan choice

A systematic review of strategies used for controlling consumer moral hazard in health systems

“…The studies included in this theme investigated consequences such as the utilization of health services, health costs, health related behavior, the choice of insurance plan, and the opinion and acceptance of consumers using quantitative, qualitative, review, and theoretical approaches (model-based), the results of quantitative studies are reported in narrative form as follows: modest to high reduction in health services and medications utilization [ 9 , 20 , 21 , 23 , 33 , 38 , 44 , 45 , 47 , 49 , 51 , 55 , 56 , 64 , 69 , 71 ], reduction in health cost [ 21 , 39 , 41 , 42 , 44 , 53 , 65 , 68 ], low or no significant effect on health services utilization [ 6 , 34 , 35 , 40 , 62 , 63 , 65 ], low or no significant effect on health costs [ 5 ], increasing cost contaminate incentive (CCI) [ 57 ], significant correlation with higher preventive behavior [ 13 , 50 ] modest efficiency gain [ 18 ], increasing medication adherence [ 48 ], increasing demand for low price drug [ 61 ], optimal insurance [ 54 ].…”

“…The reported negative consequences are as follows: Decreasing the utilization of both necessary and unnecessary care [ 44 , 55 , 71 ], substitution effect from cares with cost-sharing to free care or with lower cost sharing [ 18 , 70 ], and vulnerability of low-income groups [ 49 , 60 , 68 ].…”

“…The outcomes analyzed in the included studies are other points of debate in this review. The majority of the outcomes analyzed included demand and utilization of health services [ 5 , 15 , 18 – 24 , 30 , 33 , 37 – 40 , 43 – 45 , 47 – 51 , 55 , 56 , 58 , 60 , 62 – 65 , 68 – 71 , 75 , 84 , 86 ] and health services costs and expenditures, optimality and efficiency of strategies [ 5 , 15 , 30 – 32 , 36 , 37 , 39 , 41 – 44 , 53 , 54 , 57 , 59 , 68 , 70 , 73 – 76 , 83 , 85 , 87 , 94 ]. Limited studies have addressed other important aspects such as access to low-income people [ 49 , 60 , 68 ], reduction in the consumption of both essential (such as preventive and diagnostic services) and non-essential services [ 24 , 44 , 58 ], and people’s attitudes and acceptance [ 25 , 34 , 52 , 67 ].…”

“…Findings related to health savings accounts were extracted from seven studies [55,59,[72][73][74][75][76]. In studies related to this theme, the outcome such as health services utilization, health costs, and health promotion behaviors was assess using quantitative, review, and modelbased theoretical approaches.…”

Deductible Status in the Pediatric Population: A Barrier to Appropriate Care?

“…27 These patients may favorably select HDHPs because of their healthier status, low health care utilization, and/or a want for lower premiums. 27,28 In contrast, patients with low incomes and/or chronic conditions represent the most concerning population for HDHP coverage. Multiple studies have shown that lower-income families were more likely to report delayed or forgone care due to cost when covered by HDHPs.…”