HCCI’s First Look at Health Care Spending For People Enrolled In Consumer-Driven Health Plans Illuminates Spending and Use of Health Care Service Trends
September 13, 2016 — People with consumer-driven health plans (CDHPs) had lower total per capita spending on health care driven in part by using less health care overall than people with traditional non-CDHP commercial health plans, finds a new study from the Health Care Cost Institute (HCCI). At the same time, spending out of pocket by CDHP consumers was 1.5 times higher on average than non-CDHP consumers. For example, people enrolled in consumer-driven health plans paid an annual average $58 more out of pocket on visits to the doctor and $50 more on emergency room visits than their non-CDHP counterparts, while using roughly 8 and 10 percent fewer visits, respectively.
The study, Consumer Driven Health Plans: A Cost and Utilization Analysis, examines health care use and spending from 2010-2014 for people covered by employer-sponsored insurance (ESI) and under 65 years of age who are enrolled in CDHPs. Enrollment in CDHPs has been steadily increasing within HCCI’s employee-sponsored insurance population: more than a quarter had a CDHP in 2014, compared to just 15 percent in 2010.
Overall, the study found that that fewer total dollars were spent on health care for people with CDHPs, in part because people with CDHPs tended to use fewer health care services. However, people with CDHPs had higher spending out of pocket on deductibles, copays, and coinsurance (excluding premiums). This higher out-of-pocket spending meant people enrolled in CDHPs were responsible for nearly a quarter of their medical costs on average, compared to 14 percent for those enrolled in non-CDHPs.
“As the costs of health care increase, consumer-driven health plans try to balance lower premiums with higher deductibles and higher limits on out-of-pocket spending,” said HCCI Senior Researcher Amanda Frost. “As these types of plans grow in prevalence, it is important to look beyond premium dollars and also consider dollars spent directly on health care services.”
- Annual total spending on health care for the CDHP population was, on average, $520 less per capita than the non-CDHP population. In 2014, spending totaled $4,481 per CDHP person and $5,140 per non-CDHP person.
- Across the study period, people with CDHPs used around 10 percent fewer health care services than the non-CDHP population, and used even fewer brand prescriptions (20 percent fewer filled days than the non-CDHP population).
- On average, people with CDHPs spent $1,030 per person out of pocket annually on care, compared to $687 for the non-CDHP population.
- Of the 5 age groups studied, the group ages 19-25 was the only one in which CDHP consumers generally used more health services and had slightly higher per capita spending than their non-CHDP counterparts. Additionally, 19-25 year olds covered by a CDHP spent 81 percent more out of pocket than those without a CDHP, the largest spending difference amongst the 5 age groups.
“By using actual payments from HCCI’s commercial claims data, we are able to put numbers on commonly held beliefs to better understand out-of-pocket spending and also the trends in health care use for consumers enrolled in consumer-driven health plans,” said HCCI Executive Director David Newman. “As more employers offer consumer-driven health plans, it is critical to examine how they compare in practice to other types of health plans.”
The study presents the most up-to-date information on health care spending trends for privately insured people under age 65. It is based on fee-for-service claims provided by Aetna, Humana, and UnitedHealthcare for 40 million people per year who were covered by ESI.