TY - JOUR
T1 - Do "Consumer-Directed" health plans bend the cost curve over time?
AU - Haviland, Amelia M.
AU - Eisenberg, Matthew D.
AU - Mehrotra, Ateev
AU - Huckfeldt, Peter J.
AU - Sood, Neeraj
N1 - Publisher Copyright:
© 2016 Elsevier B.V..
PY - 2016/3/1
Y1 - 2016/3/1
N2 - "Consumer-Directed" Health Plans (CDHPs), those with high deductibles and personal medical accounts, are intended to reduce health care spending through greater patient cost exposure. Prior research agrees that in the first year, CDHPs reduce spending. There is little research and in it results are mixed regarding the impact of CDHPs over the longer term. We add to this literature with an intent-to-treat, difference-in-differences analysis of health care spending over up to three years post CDHP offer among 13 million person-years of data from 54 large US firms, half of which offered CDHPs. To strengthen the identification, we balance observables over time within firm, by developing weights through a machine learning algorithm, generalized boosted regression. We find that spending is reduced for those in firms offering CDHPs in all three years post offer relative to firms continuing to offer lower-deductible plans. The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care over the three-year window.
AB - "Consumer-Directed" Health Plans (CDHPs), those with high deductibles and personal medical accounts, are intended to reduce health care spending through greater patient cost exposure. Prior research agrees that in the first year, CDHPs reduce spending. There is little research and in it results are mixed regarding the impact of CDHPs over the longer term. We add to this literature with an intent-to-treat, difference-in-differences analysis of health care spending over up to three years post CDHP offer among 13 million person-years of data from 54 large US firms, half of which offered CDHPs. To strengthen the identification, we balance observables over time within firm, by developing weights through a machine learning algorithm, generalized boosted regression. We find that spending is reduced for those in firms offering CDHPs in all three years post offer relative to firms continuing to offer lower-deductible plans. The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care over the three-year window.
KW - Health care cost trends
KW - High deductible health plans
UR - http://www.scopus.com/inward/record.url?scp=84956646518&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84956646518&partnerID=8YFLogxK
U2 - 10.1016/j.jhealeco.2016.01.001
DO - 10.1016/j.jhealeco.2016.01.001
M3 - Article
C2 - 26851386
AN - SCOPUS:84956646518
SN - 0167-6296
VL - 46
SP - 33
EP - 51
JO - Journal of health economics
JF - Journal of health economics
ER -