- People enrolled in high-deductible consumer-directed health plans spend less on healthcare and use fewer services than those enrolled in non-CDHPs, regardless of whether they have chronic conditions, a new Health Care Cost Institute study shows.
- The researchers analyzed a sample of more than 10 million people under age 65 with employer-sponsored CDHPs and non-CDHPs between 2014 and 2016 to compare their total spending and use of services in four categories. In 2016, spending was 13% lower for CDHP enrollees versus non-CDHP enrollees, while use of services lagged across all service categories.
- Separately, a Kaiser Family Foundation and Los Angeles Times survey found four in 10 people with employer-sponsored health insurance either had trouble paying medical bills, premiums or out-of-pocket medical costs.
With rising insurance premiums and deductibles and higher out-of-pocket costs, more consumers are struggling to pay for healthcare. In an online survey of 1,734 U.S. adults by VisitPay, 84% of respondents said insurance is their No. 1 consideration in choosing where to receive treatment, and 65% said cost played a major role in overall satisfaction with a doctor or health system.
These new findings come as a number of high-profile Democrats are pushing various proposals to expand access to affordable coverage, including a single-payer or "Medicare for All" option. The debate is certain to heat up as healthcare becomes a central issue of the presidential race.
As the HCCI study and KFF/LA Times survey both show, the type of health plan a person has can have a big impact on access to care, especially for chronic conditions.
In the study, researchers looked at CDHPs, which are high deductible health plans that typically include a health savings account or health reimbursement arrangement. In 2016, CDHP enrollees spent $4,562 on healthcare versus $5,216 for non-CDHP enrollees, a difference of 13%. The gap was evident throughout the study, with CDHP spending 11% and 12% lower per person in 2014 and 2015, respectively.
The lower spending also persisted across all four service categories in 2016: inpatient (13%), outpatient (7%), professional services (8%) and prescription drugs (26%). At the same time, CDHP enrollees used less services, the researchers note, including 12% fewer outpatient services and 17% fewer prescriptions.
When it came to chronic conditions, spending by people in CDHP plans ranged from 3% less on hypertension care to 10% less for Type 2 diabetes, compared with their non-CDHP counterparts. The study also found lower service use among those with chronic conditions — in the case of hypertension, 4% to 6% less.
In the survey, experiences also differed between those enrolled in higher versus lower deductible plans. People with higher deductibles were more likely to be dissatisfied with their plans and express difficulty affording care. Among those with the highest deductibles ($3,000 for an individual or $5,000 for a family), more than half said the amount of savings they have to cover medical costs is less than the amount of their deductible.
Chronic conditions also impact affordability. Among people with employer-sponsored insurance, 54% said someone covered by their plan has a chronic condition and half of those reported problems paying medical bills or covering premiums or out-of-pocket costs. That compares with about 30% of those in families without a chronic condition.
Other survey findings include:
- Roughly six in 10 people with employer coverage say cost-related factors are the most important feature in a health plan, while a fourth cite coverage-related features — a flip from 2003 when a third said cost and six in 10 said range of benefits or choice of providers.
- Where employers offered a choice of plans, 36% selected their plan based on cost, up from 21% in 2003.
- Nearly three-fourths of those with employer coverage engaged in some form of cost-conscious behavior in the past year, most often asking for a generic drug substitute.
- Only 17% price shopped for a specific medical service, and only 9% tried to negotiate a lower price with a provider.