Health Plans
e-Newsletter
Intelligence Unit Special Reports Special Events Subscribe Sponsored Departments Follow Us

Twitter Facebook LinkedIn RSS

Are CDHP Savings All Smoke and Mirrors?

Margaret Dick Tocknell, for HealthLeaders Media, October 12, 2011

Hospitals, health plans, and healthcare reform advocates all talk a lot these days about the engaged healthcare consumer—the one with skin in the game who approaches healthcare purchases with the same money-saving zeal as a coupon clipper in a supermarket.

But how hard will the average consumer work to trim a healthcare bill? It’s one thing to save money by purchasing a less expensive brand of tuna fish, quite another to score a deal on a mammogram.

For more than a decade, consumer- directed health plans (CDHPs) have been touted as a way to give the consumer some control over healthcare spending decisions. How effective has this model been?

A group of researchers at RAND Health has been looking at how CDHPs affect healthcare spending. They’ve released three reports so far, and each one has provided another piece of the puzzle to help understand how healthcare dollars are spent. While their research shows that CDHPs reduce healthcare spending, there is also evidence that those cuts have come at the expense of necessary care, not from consumers shopping more prudently for healthcare services.

The first report, released in March 2011, looked at the effect of high-deductible plans on spending. In a study of more than 800,000 families, the researchers found that people in high deductible plans spend less money on healthcare. That’s the good news. But they spend less money because they forgo preventive healthcare such as childhood shots and cancer screening. Oops, there’s the bad news.

1 | 2 | 3

Comments are moderated. Please be patient.

5 comments on "Are CDHP Savings All Smoke and Mirrors?"


William (10/28/2011 at 3:43 PM)
For over 12 years many academic researchers have misunderstood consumer-directed health care. High deductibles are not CDH plans, they are high deductibles. Without any spending account underneath the deductible there is no need to conserve scare resources, which is the primary incentive in a consumer directed market. Kaiser FF realized this a few years ago and now separates out the HD plans from the CDH plans. I wish they all would.

James (10/13/2011 at 1:32 PM)
I've been enrolled in a CDHP since 2005, and never have skipped care. It could be that I've been fortunate that my employers have offered 100% coverage of preventive care (which I think with reform is mandatory now), and my health plan provides all the education, cost and quality research tools, and nurse coaching that helps me make a informed decisions about how to save money, and what the consequences of skipping needed care would be. I'd be interested to see if RAND notes in their newest report what the typical amount of services to treat the studied episodes of care are. Of course, that could even vary by episode severity. All in all, I'm a fan of these plan designs if they are designed correctly, and not just as a way to shift cost to employees. It's changed my behavior in a good way, and most of my coworkers would agree.

Mary Malone (10/13/2011 at 11:13 AM)
All great points about an increasingly important topic. Here's my (slightly different)take: Where is the evidence that demonostrates that 10 visits produces the "best wrist outcome"? Is the "best wrist outcome" actually achieved with 15 visits (and insurers historically let hospitals bill for only 10)? Perhaps the "best wrist outcome" occures with 3 visits and good patient education for home exercise(but hospitals historically were able to bill for 10 and did?) Maybe the number varies based upon the type of break and type of patient (older, younger, athlete,etc.)? Perhaps the patients know best and an average of 5 visits is the right number. Without research, it is difficult to draw a conclusion.