Money-saving health plans do little to curb spending on unnecessary medical services
By a
Researchers from the
"Consumer-directed health plans are a type of high-deductible plan that was basically created to save money and encourage consumers to spend less on health care," said corresponding author
The researchers compared patient spending on unnecessary medical services, such as an MRI for lower back pain or imaging for an uncomplicated headache, before and after they switched from a traditional insurance plan to a consumer-directed health plan - a form of a high-deductible insurance.
The study published on
"Overall, I don't find much evidence that these high-deductible plans are helping consumers make smarter decisions," Sood said.
Unnecessary services add up to an estimated
Skin in the game
Patients on consumer-directed health plans share more costs for their care than patients on traditional plans as they pay a higher deductible. With the high-deductible plan, a patient can open a pre-taxed health care savings account and use it to pay for out-of-pocket medical services. Sood said this type of plan is often pitched as way to give consumers more skin in the game, presuming that they will shop and compare prices for services or skip unnecessary care and therefore spend less.
Sood noted that enrollment in these plans has risen dramatically in the last decade, with a nearly seven-fold increase. Only about 4 percent of Americans with employer-sponsored insurance were on a consumer-directed health plan in 2005, compared to about 30 percent today. The vast majority of individuals who obtained insurance under the Affordable Care Act are on consumer-directed health plans.
"Theoretically, the increased cost-burden of those plans could be an incentive for consumers to pinch pennies by specifically avoiding low-value services that don't offer them clear clinical benefits," said
"Instead, we found that patients are reducing their spending overall, but not for low-value services in particular," said Reid, who also is a primary care physician at
"A high deductible may be too blunt an instrument for patients to specifically cut unnecessary services," she added. "That said, we also know that medical providers also often lack incentives to curb spending on these frequently ineffective services."
Small effect on a big problem
The latest study was based on a random 25-percent sample of
The researchers compared unnecessary medical service claims for 365,016 patients who were on traditional plans with the claims filed for 11,075 patients who switched from a traditional plan to a consumer-directed health plan. The study accounted for patient characteristics including age, race, sex, income and health conditions.
The study focused on 26 common, low-value services from various sources, including the Choosing Wisely campaign, national guidelines, peer-reviewed literature and professional consensus. Launched in 2012 by the
The researchers found that spending on unnecessary services did not significantly change after a patient switched plans. The high-deductible plan did, however, result in an average, annual
Keywords for this news article include: Legal Issues, Managed Care, Health and Medicine, Diagnostics and Screening,
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