Impact of a High-Deductible Health Plan on Outpatient Visits and Associated Diagnostic Tests
Published Date:Jan 2014
Source:Med Care. 52(1):86-92.
Pubmed Central ID:PMC5147026
Funding:P30 DK092924/DK/NIDDK NIH HHS/United States
U58 DP002719/DP/NCCDPHP CDC HHS/United States
1P30-DK092924/DK/NIDDK NIH HHS/United States
5U58DP002719-03/DP/NCCDPHP CDC HHS/United States
By shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services.
To examine the impact of a HDHP on outpatient visits and associated laboratory and radiology tests.
We used a pre-post with comparison group study design to examine the differential change in outpatient service utilization among 7953 adults who were switched from a traditional HMO plan to a HDHP compared with 7953 adults remaining in traditional plans. HDHP members had full coverage of preventive laboratory tests and modest copayments for outpatient visits, similar to controls, but faced full cost sharing under the deductible for radiology tests and laboratory tests not classified as preventive.
Compared to controls, the HDHP group experienced moderate relative decreases in overall office visits (ratio of IRRs=0.91, or a 9% relative reduction; 95% confidence interval 0.88, 0.94) and visits for higher (0.91; 0.85, 0.97) and lower-priority (0.89; 0.81, 0.99) chronic conditions. There were no significant differences in changes in visit rates for acute higher or lower-priority conditions (both 0.93; 0.86, 1.01) or preventive laboratory tests (0.97; 0.93, 1.02). HDHP members showed moderate relative reductions in the use of general laboratory tests (0.91; 0.86, 0.97) but not radiology tests (0.97, 0.91, 1.03).
Chronic outpatient visits declined among HDHP members, although preventive labs and acute visits remained unchanged. HDHP patients with chronic illnesses who have more contact with the health care system might be more likely to reduce utilization because of increased exposure to costs associated with ambulatory visits.
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