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June 1, 2012

Expanding Consumer-Directed Health Plans Could Help Cut Overall Health Care Spending

Photo by Zerbor/Getty Images

If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.

Consumer-directed health plans, which include high deductibles paired with personal health accounts, are a market-based approach that many employers have adopted to address health care spending. Such plans now account for about 13 percent of all employer-sponsored health coverage.

A RAND study published in the journal Health Affairs found that among families enrolled in consumer-directed health plans, about two-thirds of the savings were the result of fewer encounters with health care providers. The remaining third was caused by lower spending per encounter, suggesting patients were making different choices about tests and treatments. Families in consumer-directed plans used fewer brand-name drugs, had fewer visits to specialists, and had fewer elective hospital admissions than families in traditional plans.

This is the last in a series of four studies looking at issues of cost and quality in consumer-directed health plans. The studies did not provide evidence regarding the long-term effects of consumer-directed health plans on health outcomes.

The previous studies found that while high-deductible health plans significantly reduced health care spending, consumers with these plans cut back on their use of recommended preventive health care. However, those with low incomes or chronic health problems enrolled in high-deductible health plans are at no more risk for cutting back on needed health care than others enrolled in these plans. Lastly, contrary to earlier research on cost sharing in which patients had little or no control over their health care spending once they began to receive a physician's care, those in consumer-directed health plans reduced their costs even after they initiated care.