High Deductibles Not Sufficient To Change Employee Behavior: EBRI

High-deductible health plans might help make members more selective early in their plan year, but once they meet that deductible, all bets are off. A report from the Employee Benefit Research Institute shows that the likelihood of using low-value health services increases by as much as 83% once plan members meet their deductible. That includes services like cancer screenings below recommended ages, imaging for uncomplicated headaches, and vitamin D or prostate-specific antigen tests.

“Proponents of HDHPs argue that high cost-sharing can enhance consumers’ tendency to discriminate between high- and low-value health care services, however, a proportion of enrollees will satisfy health plan deductibles, no matter how high,” Paul Fronstin, director of EBRI’s Health Research and Education Program and co-author of the report, said in a statement.

Fronstin suggested that “when a plan deductible is met, relatively low levels of cost-sharing thereafter releases pent-up demand for care, including low-value medical services. Alternatively, meeting a health plan deductible may be associated with less patient scrutiny over the value of health care services being prescribed by health care providers.”

EBRI used 2015 from the Truven Health Analytics MarketScan®Commercial Claims and EncountersDatabases(CCAE) and the Benefit Plan Design (BPD) Database for the study. The dataset included 1.5 million full time employees.

The study identified low-value services that saw dramatic increases in utilization among members who satisfied their plan’s deductible:

  • * Colorectal cancer screening under age 50 — 126%
  • * Imaging for uncomplicated headache — 83%
  • * Chest X-rays prior to hernia repair surgery — 73%
  • * Laboratory testing for vitamin D deficiency — 68%
  • * Cervical cancer screening under age 50 — 33%
  • * Imaging for low-back pain — 28%
  • * Screening for prostate cancer (men of any age) — 21%

EBRI’s findings hold for members in high-deductible plans as well as traditional plans. The organization called deductibles a “blunt” tool when it comes to changing participant behavior.

“A lack of nuance in plan design regarding coverage of low-value services may contribute to the observed patterns for those enrollees who satisfy their deductibles (or expect to). Plan sponsors likely miss opportunities to encourage smarter shopping when commonly overused services are treated no differently than unambiguously high-value services for purposes of cost-sharing,” according to the report.

For example, the State of Oregon charges public employees a surcharge for commonly overused services, which led to a 13% reduction in utilization of those services, EBRI found.


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