Another interesting piece of research on the effects of high-deductible health insurance plans comes from the Health Care Cost Institute. (HCCI Report) The researchers used that significant database to examine differences in utilization and spending among under-65 enrollees covered by high deductible employer-sponsored plans versus those covered by more traditional benefit designs. There was no risk adjustment, so some of the effects seen could be due to healthier persons enrolling in HD plans, which in prior research has often been shown to be the case. During the period 2010 to 2014, the high deductible plan members had lower average annual health spending, and the gap with spending by non-high deductible plan members grew each year. In 2014, average spending for the HD enrollee was $4481 versus $5140 for traditional enrollees. The high deductible members picked up more of their spending, both in dollar and per cent terms. Across the study period, annual out-of-pocket spending for them was $1030, or 24% of costs, compared to $687, or 14%, for non-HD members. The trend was similar across most age cohorts, although those aged 19-25 had similar spending in both plan types. This age group is low-spending in any event. In additions, the HD enrollees had lower utilization rates for almost all services, generally using about 90% of the number of services that non-HD members used.
Spending was lower across all service categories, and most noticeably lower for prescription drugs, where non-HD plan members had average spending 28% higher than did HD enrollees. Across other categories, the difference was a total of about 9%, with inpatient hospitalizations chipping in about 15% more spending. About two-thirds of the drug spending difference was attributable to more spending on brand-name drugs among the non-HD members, which was also reflected in significantly greater brand drug utilization. One thing not covered by the study is relative premium cost-sharing. Typically a high deductible plan enrollee will have significantly lower premium sharing, which reduces their total direct spending on health care. It should also be noted that the authors did not have access to whether the enrollees in the high deductible plans had health savings or health reimbursement accounts and how they may have funded or used those accounts. Many people in high deductible plans do have these accounts and they reduce the net out-of-pocket spending substantially. Overall, the study suggests that high-deductible plans are working as intended–they are reducing health services utilization and spending. What this study can’t tell us is whether the reduction in services comes among low-value treatments, or are the members skipping needed care.