High-deductible health plans reduce use of both needed and unneeded services, research finds

A new research review reveals that high-deductible health plans lower costs by reducing enrollees’ use of healthcare services—including preventive care.

The review, published in this month’s edition of Health Affairs, examines the results of 28 different studies on the impact of HDHPs on healthcare utilization and costs.

It found that in 7 out of 12 studies, HDHPs were associated with a “significant” reduction in preventive care. Researchers note that one study pointed to an explanation, as it found HDHP enrollees sometimes forgo needed care to save money.

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Yet most HDHPs don’t charge members for preventive screenings, suggesting patients that forgo such care due to cost concerns may not understand their benefits, according to study author Nir Menachemi, of Indiana University–Purdue University Indianapolis.

"For high-deductible health plans to work in the ideal, patients need to be educated on the fact that preventive care does not usually incur out-of-pocket costs in these types of plans," he said.

This is especially true, the study notes, given that efforts to repeal and replace the Affordable Care Act have aimed to make HDHPs with health savings accounts more attractive to consumers.

In 6 out of 11 studies on the HDHPs’ effect on office visits, meanwhile, those types of plans were associated with reduced use of that service, leading to a reduction in both appropriate care and inappropriate care. Researchers also found evidence that HDHPs may be associated with a reduction in medication adherence.

Future studies, researchers add, should examine “the effects of HDHPs on the health and well-being of individuals and populations.”

Other recent research has noted that deductibles have risen considerably for employer-sponsored health plans in recent years. In fact, the share of the share of adults with employer-based coverage who are enrolled in HDHPs rose from 26.3% in 2011 to 39.3% in 2016, according to the Centers for Disease Control and Prevention. That report also noted that those in employer-based HDHPs tended to have greater problems paying medical bills than those in traditional plans.

HDHPs are also common on the ACA exchanges, which has led to concern about how high levels of cost-sharing are affecting consumers.