Consumer-directed health plans were largely designed as a way to shift more of the rising cost of health care to employees by bringing back high deductibles and often higher copays or coinsurance for services. They have often been coupled with health reimbursement or health savings accounts as a way to help employees manage the cost shifting. The research to date shows a steady growth in membership. People covered by these plans tend to show a greater satisfaction than might be expected and in general they have used preventive services more. A new article in Health Affairs projects what the effect of even greater use of CDHP plans might lead to. (HA Article) In 2010 about 13% of commercial enrollment was in high-deductible plans and more than half of large employers offer at least one such option in 2011 with more planning to do so in 2012. Certain aspects of the reform law may encourage even more use of these plans.
The authors projected potential savings if this form of insurance covered 50% of employer-sponsored health insurance. If the CDHP was accompanied by a 50/50 mix of health reimbursement accounts and health savings accounts, the savings would be about $57 billion dollars. If it were 100% health savings accounts, the spending reduction would be $73 billion. About two-thirds of the savings are in fewer episodes of care and one-third in lower spending per episode. While the increased cost-share has raised concerns about people skipping necessary care for cost reasons, the fact that preventative care must be covered without copays and that value-based designs are being incorporated into CDHP should lessen this concern. It is likely that healthier people select CDHP coverage, meaning that regular coverage premiums will likely rise more. It also will be important to help CDHP enrollees have tools and education to raise their ability to become good health care shoppers. But in general this trend supports the healing of the health care market by returning responsibility to individuals.