Are the Healthy Behaviors of US High-Deductible Health Plan Enrollees Driven by People Who Chose These Plans? Smoking as a Case Study

Jeffrey T. Kullgren, Kevin G. Volpp, Daniel Polsky

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To determine whether negative associations between enrollment in a high-deductible health plan (HDHP) and one exemplar unhealthy behavior - daily smoking - are found only among people who chose these plans. Design: Cross-sectional analysis of nationally-representative data. Setting: United States from 2007 to 2008. Subjects: 6,941 privately insured non-elderly adult participants in the 2007 Health Tracking Household Survey. Measures: Self-reported smoking status. Analysis: We classified subjects as HDHP or traditional health plan enrollees with employer-sponsored insurance (ESI) and no choice of plans, ESI with a choice of plans, or coverage through the non-group market. We used multivariate logistic regression to measure associations between HDHP enrollment and daily smoking within each of the 3 coverage source groups while controlling for potential confounders. Results: HDHP enrollment was associated with lower odds of smoking among individuals with ESI and a choice of plans (AOR 0.55, 95% CI 0.33-0.90) and those with non-group coverage (AOR 0.64, 95% CI 0.34-1.22), though the latter association was not statistically significant. HDHP enrollment was not associated with lower odds of smoking among individuals with ESI and no choice of plans (AOR 1.04, 95% CI 0.69-1.56). Conclusions: HDHP enrollment is associated with lower odds of smoking only among individuals who chose to enroll in an HDHP. Lower rates of unhealthy behaviors among HDHP enrollees may be a reflection of individuals who choose these plans.

Original languageEnglish (US)
Article numbere56154
JournalPloS one
Volume8
Issue number2
DOIs
StatePublished - Feb 13 2013
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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