High-Deductible Plans Tied to Reduced Use of Health Care, Including Diagnostic Testing

People enrolled in high-deductible health plans (HDHPs) cut their use of health services, including laboratory testing, according to a study published in the October issue of Health Affairs. HDHPs lower health care costs as a result of a reduction in the use of health services, including appropriate services, the authors conclude.

“Our review highlights the adverse effect of HDHPs on the use of preventive services,” write the authors led by led by Rajender Agarwal, director of the Center for Health Reform, in Dallas, Texas. However, the authors note that few HDHPs charge members for preventive screenings, suggesting patients don’t understand they could receive these services at no cost.

HDHPs are generally defined as a health plan with an annual deductible of at least $1,300 for individual coverage or $2,600 for family coverage. The share of adults with employer-based coverage who are enrolled in HDHPs rose from 26.3 percent in 2011 to 39.3 percent in 2016, according to the National Center for Health Statistics.

Employers and policymakers often see these plans as a potent way to curb health care costs, believing that the higher cost-sharing requirements will incent patients to make “higher-value” health care decisions. However, early evidence suggests that patients, particularly those in low-income and vulnerable populations, lower utilization of both appropriate and inappropriate services.

The researchers conducted a systematic literature review to identify quasi-experimental studies that compared an HDHP with a traditional health plan. The 28 included articles assessed health care use and spending for any health care setting, including preventive care, office visits, emergency department visits, hospitalizations, diagnostic testing, and prescription drug use.

Findings show that the plans appear to reduce health care costs by decreasing the use of both appropriate (such as cancer screening) and inappropriate (such as

low-severity emergency department visits) health services.  Seven of 12 studies showed that HDHPs were associated with a significant reduction in preventive care. Additionally, six of 11 studies showed a significant reduction in office visits, which led to a reduction in appropriate and inappropriate downstream care.

Only two studies specifically studied the impact of HDHPs on laboratory and diagnostic testing. These two studies showed a reduction in laboratory and diagnostic tests among HDHP enrollees, although the researchers were unable to determine whether these reductions were appropriate.

Takeaway: Early evidence suggests that diagnostic testing volumes are likely negatively impacted by patient enrollment in HDHPs, which are associated with a reduction in the use of health services, including appropriate and preventive services.