High-deductible health plans have aided employers in containing healthcare costs without immediately leading to more expensive healthcare needs for patients, new research suggests.
After three years of offering high-deductible plans, employees at several large U.S. companies did not record increased levels of care in the emergency department or hospital, according to a new working paper from the National Bureau of Economic Research, a not-for-profit, nonpartisan research organization. The study contained several limitations, however, and won't end debate about who benefits more from such plans—consumers or the employers offering them.
“Employers are really worried about controlling healthcare costs,” said Neeraj Sood, director of research at the University of Southern California's Schaeffer Center for Health Policy & Economics and co-author of the paper. “This research definitely shows that offering high-deductible plans is an effective strategy for doing that, at least over a three-year horizon.”
High-deductible plans have proliferated among employers, as well as on the Affordable Care Act exchanges. Employers and insurers have turned to the plans to lower premiums, and shift more out-of-pocket costs to consumers. Economists agree that high-deductible options are part of the reason why U.S. healthcare spending has grown so tepidly over the past several years.
But high-deductible plans also have been controversial, raising concerns that patients may skimp on both unnecessary and necessary preventive care to avoid large medical bills. Roughly 60% of adults with low or moderate incomes believe their deductibles are “difficult or impossible to afford,” according to the Commonwealth Fund.
Sood and colleagues sifted through enrollment and claims data from 54 large U.S. employers. The data covered 13 million people from 2003 to 2007 and compared those who worked at companies with high-deductible options with individuals who worked at firms without those options.
Annual healthcare spending was 6.6%, 4.3% and 3.4% lower on average in the first three years for companies with high-deductible plans when compared to companies without them. Most of the difference came from lower spending on prescription drugs and outpatient care. Additionally, there were “no differences in either emergency department or inpatient spending” by the end of the third year, the paper said.
The authors listed the caveat that they “cannot rule out” that healthcare spending decreases could be a one-time occurrence for some companies or that forgoing care could lead to higher expenses much further down the road. Sood also said the cost-shifting of high-deductible plans could hurt some employees more than others.
“There is no free lunch, that is true,” Sood said. “That is a drawback of these plans. They put a greater financial strain” on low-income individuals.
But there are ways to mitigate out-of-pocket expenses, Sood said. Health savings accounts can help patients put aside money for emergencies, and many employers are offering online tools to help patients shop for elective healthcare.
About 20% of workers are enrolled in high-deductible health plans, according to the Kaiser Family Foundation. In 2006, only 4% of employees had those types of plans.
