Dive Brief:
- According to a new working paper by the NBER, spending is reduced for those at companies offering consumer-directed health plans (CDHPs) for all three years post offer, primarily as a result of decreased spending for outpatient care and pharmaceuticals. The report notes there was no evidence of increases in emergency department or inpatient care.
- CDHPs feature high deductibles and personal medical accounts, and are designed to reduce healthcare spending through more patient cost sharing.
- While previous research had demonstrated that CDHPs reduce spending during their first year of implementation, there was insufficient research into their results over a longer timeframe. The NBER study authors have filled that void by examining data from 13 million people at 54 large US companies to estimate the impacts of CDHPs on healthcare spending for up to three years.
Dive Insight:
This study provides promising data on the long-term financial impacts of CDHPs. At the same time, however, it acknowledges that it has limitations in assessing the strategic value of these plans.
One of those limitations, the authors note, is that the study only looked at large employers and did not consider differences with Medicaid beneficiaries, the individual or small group market, or the health insurance exchange.
Given that some questions remain, the study may not resolve the common concern that CDHP plan members could end up more expensive in the long run if they decrease their use of care in the near-term and ultimately wind up with complications as a result.
"In summary, in the first large multi-employer study to investigate long term CDHP spending impacts we find reductions in healthcare cost growth in all three years post CDHP offer and do not detect increases in any component of health care spending," the authors state. "These findings do not support either the concern that decreases in spending will be a one-time occurrence or that short-term decreases in spending with a CDHP will result in increases in spending in the long term due to complications of forgone care. We cannot rule out either of these concerns developing over an even longer time frame."