Low-Value Service Use Under High-Deductible Plans

Low-value health services, oooh, scary stuff, boys and girls.  Do high-deductible health plans encourage less of their use; that is the question examined by researchers in a study published at AJMC.   (AJMC Article)   They used data from a large national insurer from 2011 to 2013 on over 375,000 adult patients under age 65 enrolled in a high-deductible plan.  The premise of high-deductible plans was that they would help consumers pay more attention to the health care they receive, compare prices, etc.  Theoretically, low-value services would be the place consumers might limit consumption first.  But of course that assumes that patients understand what a low-value service is and/or agree that it is low-value.  The basic analysis of this research was a comparison of utilization by people who stayed in a traditional health plan versus those who switched from a traditional plan to a high-deductible one during the study period.  The patients in each group were matched on a variety of demographic and other characteristics.  Use of 26 low-value services from the Choosing Wisely campaign was examined.

In the year after switch to a high-deductible plan average annual outpatient spending declined by $100.93 per consumer, while outpatient spending rose $130.67 for those remaining in a traditional plan; for a total difference of $231.60.  Low-value service spending decreased by $7.93 for switchers and decreased $4.29 for those staying in traditional coverage.  This is not a statistically significant difference.  There was a small association between switching to a high-deductible and less spending on low-value imaging, but not for low-value lab testing services.  There was also no significant difference in low-value service use for those with high patient preference sensitivity.  The results overall suggest that patients received less outpatient care, but weren’t necessarily focusing on avoiding low-value services in reducing their spending.  Of course this was only a one-year study and I think that is far too short a time for consumers to adapt their behavior.  This and other research may also suggest that it is better to focus on getting providers to avoid delivering or ordering low-value services than to expect patients to suddenly become expert health care consumers.