Address correspondence to Teresa M. Waters, Ph.D., Associate Professor, Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline St., Suite 633, Memphis, TN 38163; e-mail: firstname.lastname@example.org. Cyril F. Chang, Ph.D., Suzanne Downs Palmer Professor of Economics and Director of Methodist Le Bonheur Center for Healthcare Economics, is with the Fogelman College of Business and Economics, The University of Memphis, Memphis, TN. Panagiotis Kasteridis, Ph.D., Postdoctoral Research Associate, is with the Department of Agricultural and Resource Economics, The University of Tennessee, Knoxville, TN. William T. Cecil, M.B.A., Research Fellow, Methodist Le Bonheur Center for Healthcare Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN. David Mirvis, M.D., Professor, is with the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
Impact of High-Deductible Health Plans on Health Care Utilization and Costs
Article first published online: 28 OCT 2010
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 1p1, pages 155–172, February 2011
How to Cite
Waters, T. M., Chang, C. F., Cecil, W. T., Kasteridis, P. and Mirvis, D. (2011), Impact of High-Deductible Health Plans on Health Care Utilization and Costs. Health Services Research, 46: 155–172. doi: 10.1111/j.1475-6773.2010.01191.x
- Issue published online: 3 JAN 2011
- Article first published online: 28 OCT 2010
- High-deductible health plans;
- health insurance;
- health care utilization;
- chronically ill
Background. High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model.
Objective. To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans.
Data. Claims and member data from a major insurer and zip code-level census data.
Study Design. Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls).
Results. In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan.
Conclusions. Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives.