High Deductible Plans Do Little to Trim Use of Low-Value Care

Study suggests patients influenced more by providers than potential out-of-pocket costs.

When it comes to using low value health care services, patients still trust their doctors more than they do their own wallets.
That’s the takeaway from a new study that looked at the effect of high-deductible health plans on the use of medical services that offer little or no clinical value to patients. That’s bad news for employers that are counting on HDHPs to make employees more discerning about the value of care they receive and, as a result, help their employers reduce health care spending.
The study, which appeared in the American Journal of Managed Care, compared the change in the use of low-value medical services between 2012 and 2013 by two groups of commercially insured patients. The first group of 365,016 patients had traditional PPO or HMO coverage and didn’t change plans from one year to the next. The second group of 11,075 had traditional PPO or HMO coverage in 2012 but switched to an HDHP in 2013. By definition, an HDHP has an annual deductible of at least $1,300 for individual coverage and at least $2,600 for family coverage.
Low-value medical services are services that, based on the medical literature, offer little or no clinical value to patients. The study examined the use of 26 low-value services by the two groups of insured patients, including:

  • A stress test for stable coronary artery disease
  • A CT scan for a sinus infection
  • Arthroscopic surgery for an arthritic knee
  • A spinal injection for lower back pain

In theory, the researchers proffered, patients with HDHPs would be less likely to use low-value medical services because a greater share of the cost would come out of their own pockets. These patients would be incented to seek out and use services that offered the biggest clinical bang for the buck. Patients with traditional coverage would be less discerning because their plans picked up most of the cost anyway.
As it turned out, HDHPs made a difference but not much. The average annual spending on the 26 low-value services dropped by $7.93 per HDHP patient compared with $4.29 per non-HDHP patient. For every $10,000 spent on outpatient care, spending on low-value services dropped $15.54 for patients with HDHPs compared with $7.68 for those with traditional coverage. The study said the differences in the two measures of low-value spending were not statistically significant.
“The lack of effect of (HDHP) enrollment on even those low-value services more sensitive to patient preferences and demand may support the argument that the most effective locus to spur value-conscious decisions may not be patients, but providers,” the study said.
In other words, the researchers suggested that hospitals and doctors may be in a better position to dissuade patients with high deductibles from using medical services that won’t do much to improve their medical condition. The findings suggest that hospitals and doctors have yet to use that power.
To learn more about what employers can do to influence the use of low-value medical services by their workers, read “Overuse of Medical Services Drives Up Costs for Everybody” in the September issue of Twin Cities Business.