Panel Paper:
Effects of Employer-Offered High-Deductible Health Plans (HDHPs) on Low-Value Spending in the Privately Insured Population
*Names in bold indicate Presenter
Abstract: Enrollment in high-deductible health plans (HDHPs) has increased more than seven folds in the last decade. Proponents of these plans argue that high deductibles could reduce wasteful spending by providing patients with incentives to limit use of low-value services that offer little or no clinical benefit. Others are concerned that patients may respond to these incentives by reducing their use of medical services indiscriminately regardless of clinical benefit, which may negatively impact health outcomes. This study uses individual-level data from the Truven Health MarketScan® Research Databases (2008-2013) and plausibly exogenous changes in plan offerings within firms over time to estimate the intent-to-treat (ITT) and local-average treatment effects (LATE) of HDHPs on spending on 26 low-value services received in the outpatient setting. We find that firm offer of a HDHP leads to a 7.0% ($2.10) reduction in spending on the outpatient low-value services measured and 7.6% ($147.30) in overall outpatient spending. We find similar results when limiting our analyses to spending on measures of low-value imaging and laboratory services. We find no evidence that HDHPs disproportionately reduce low-value spending relative to their effect on overall spending. HDHPs may represent too blunt an instrument to specifically curtail low-value spending.
