High-deductible Plans and Preventive Care Use

As high-deductible plans, and other plans with higher consumer cost-sharing, continue to gain market share, researchers properly focus on the impacts of this greater cost-sharing on care-seeking behavior.  Preventive care–immunizations, regular wellness visits, disease screenings–are thought to help keep individuals in optimal health and to deter longer-range spending, so the impact of higher cost-sharing on this category of care may be particularly informative.  A study in the Journal of Health Economics covers this topic.   (JHE Article)   Theoretically, it shouldn’t matter, since the ACA makes preventive care free of cost-sharing, but many preventive visits entail other services that are subject to cost-sharing, and consumers aren’t always aware of the lack of cost-sharing on preventive care.  The authors used 2004 to 2007 data (I can never understand why such dated data is used in these studies, it isn’t hard to get more recent information)  from 37 large firms which either had or began offering a CDHP during the study period to determine the effect on cancer screenings.

The individuals whose behavior was studied were employed continuously over the study period and were in the defined group which was recommended to get breast, cervical or colon cancer screenings.  All individuals had first-dollar coverage for these screenings.  The three-year study period allowed for examination of whether behavior changed as employees became habituated to their CDHP coverage.  There was evidence of a modest “stockpiling” effect; that is, more employees sought screenings in the period before CDHP enrollment, probably due to a misconception that they would potentially be paying for them.  There were no significant differences in use of all three cancer screenings after enrollment in the CDHP compared to before or to a control group.  CDHP enrollment was associated with significant declines in utilization of three services similar to the preventive screenings, such as any imaging or endoscopy.  In a possible example of consumer misunderstanding of their benefits, in years after enrollment in a CDHP, employees continue to get more breast and cervical cancer screenings in the last quarter of the benefit year, as though they thought the cost to them (which is zero) were going up, although this seems contrary to the lack of reduction in overall screening rates.  The good news is that at least for these screenings, being in a CDHP does not seem to reduce use.