Some CDHP members forgo care: Study

Consumer-driven health plans may have lower premiums and discourage unnecessary care, but they also are inducing some plan members to forgo needed care, a study by RAND Corp. has found.

The plans, which in 2005 were offered by about one-fifth of U.S. employers that provide health insurance, are attracting healthier and wealthier employees, according to the study by the nation's largest independent health policy research organization that was published Tuesday in the journal Health Affairs.

RAND researchers, who examined the results of dozens of other earlier studies--some conducted by the health plans themselves--to draw their own conclusions, also found that consumers are struggling to find reliable information on quality and price, information needed to help CDHP members make wise health care spending choices.

"We know there's a lot of uneven health care quality--it's even difficult for medical professionals to judge," said Melinda Beeuwkes Buntin, co-director of the Bing Center for Health Economics at Santa Monica, Calif.-based RAND and lead author of the study, "Consumer-Directed Health Care: Early Evidence About Effects on Cost and Quality."

"Now we're asking patients to become good consumers and consider not only quality of care, but price. They need more information to do that properly," she said in a statement announcing the study's findings.

Most employers offering consumer-driven plans save between 10% and 25% on health care costs, though some of those savings are attributable to cost-shifting to plan members, according to the study.

Meanwhile, employees and dependents enrolled in CDHPs without health savings accounts spend approximately 4% to 15% less than those in traditional health plans, while those in plans with HSAs spend about 2% to 7% less, according to the study.

The study also found that only about 4% of employers offering high-deductible plans also offer either an HSA or health reimbursement arrangement to accompany them.

RAND researchers found that while some of the savings are a result of plan members spending less on unnecessary care, such as not going to the emergency room or demanding antibiotics for viral infections, other savings were the result of plan members not seeking necessary care, such as not filling prescriptions or having doctor-recommended follow-up care.

"The evidence is really mixed," Ms. Buntin concluded. "There are some studies in which people are reporting that they don't fill a prescription or they don't get follow-up that's recommended by a doctor. So those two things would be a cause for concern."

Researchers also advised plan sponsors to monitor the disparity created by the fact that employees switching to consumer-driven plans tend to have higher incomes and better health than those enrolled in traditional health plans.

The study, which is part of a four-year, $4 million research program co-sponsored by the California HealthCare Foundation and the Robert Wood Johnson Foundation, is available online at www.healthaffairs.org. Among other things, the research program will examine the effect of high-deductible health plans, both with and without HSAs, on the use and quality of care.