High-deductible health plans are linked to fewer ER visits

Patients who switched to high-deductible health plans went to the emergency department 10 percent less than patients who remained in traditional plans, according to a new study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). The study, published in the March 14 Journal of the American Medical Association, shows that most of this reduction was for less severe conditions like colds, nausea, and headaches. The authors followed members for approximately one year after the switch to the high-deductible plan.

“Our study showed that for most members, the high-deductible plan seemed to work as intended,” said Frank Wharam, research fellow in the Department of Ambulatory Care and Prevention and the study’s lead author. “Patients went to the emergency room less frequently for nonemergency conditions.”

However, the authors stress that more research is needed to determine long-term health consequences and the impact on different segments of the population. “It will be important to determine how the health of low-income and chronically ill patients is affected,” said Wharam. “Our study could not provide conclusive answers. Ideally, high-deductible plans will be structured so that all patients readily seek care when they think they have an emergency.”

High-deductible health plans are playing a central role in Massachusetts health insurance reform efforts. Nationwide, they have become increasingly popular as a way to stem rising health care costs and make insurance more affordable to individuals and employers. Monthly premiums are lower than traditional health insurance plans but enrollees must pay for most medical services up to a deductible amount that averages $1,000 to $4,000 per year. Emergency department visits and hospitalizations are often subject to the deductible.

The study compared approximately 60,000 members enrolled in a traditional health insurance plan in Massachusetts with more than 8,700 members working for employers who switched to offering only a high-deductible plan. The high-deductible plans studied were not federally qualified high-deductible health plans (aka health saving accounts plans) because office visits and prescription drugs were not subjected to the deductible. The researchers examined patients’ emergency department diagnoses to determine the effect on visits for high severity conditions (such as asthma or kidney stones) and low severity conditions (such as headaches, nausea, or colds).

There was a slight decline in first-time emergency visits for members in high deductible plans and a 25 percent reduction in repeat visits, mostly for nonsevere conditions. This suggests that when members realize their responsibility for out-of-pocket expenses, they reduce future emergency department visits for less urgent conditions. Patients in the high-deductible plans were also hospitalized less as a result of both reduced emergency visits and fewer admissions once reaching the emergency department.

This work was supported by the Harvard Pilgrim Health Care Foundation.