HDHPs Associated With 14% Decline in Health Spending

A study of high-deductible health plans reveals mixed results in terms of how these plans help cut health spending while maintaining quality care. Although HDHPs can significantly reduce health spending, they may also prompt patients to cut back on preventive health care, according to a RAND Corp. report.

The findings are important because HDHPs are expected to be a key offering in the insurance exchanges being set up in many states to help the uninsured find health coverage.

From 2004-2005, researchers studied more than 800,000 families insured through 53 large employers. About half of the employers offered an HDHP. The families were tracked over the first year of enrollment. Different patterns could emerge in subsequent years.

According to the study, high deductible plans resulted in an average 14 percent decline in health spending compared to lower deductible plans. The savings, however, decreased when employer contributions accounted for more than half of an individual's deductible. So, it appears the insured looked for ways to save money when it was their own, but that was not as much of a concern when they were less vested financially.

The amount of the deductible also made a difference. The study findings note that costs drop as long as the deductible is at least $1,000 per person.

The reduction in the use of preventive care was a disconcerting discovery. Childhood vaccination rates fell among enrollees in HDHPs as did the rates of mammography, cervical cancer, and colorectal cancer screening. This is a particularly troubling finding because HDHPs in the study waived the deductible for preventive care.

Researchers suggest that this may just be a communication problem that could be resolved by insurers providing more information about the waiver of health plan deductibles for preventive treatments.

• Health costs increased for enrollees in both high-deductible and traditional plans but grew more slowly in the high-deductible group.
• HDHP enrollees spent less on both inpatient and outpatient medical services, as well as prescription drugs. Spending for emergency care did not differ from traditional plans.
• Individual deductibles must be rather high ?more than $1,000 per person? to achieve meaningful cost savings.