The Health Care Cost Institute has released its analysis of claims data for the years 2010 through 2014, comparing consumer-driven health plans (CDHPs, which HCCI defines as High-Deductible Health Plans coupled with Health Savings Accounts or Health Reimbursement Arrangements). HCCI examines a database of claims submitted by Aetna, Humana, Kaiser Permanente, and UnitedHealthcare for their employer-sponsored group plans.
CDHPs shift payment from third-party bureaucracies (that is, insurers) back to patients directly. The results continue to impress:
In 2014, per capita spending for the non-CDHP population was $659 greater than that for the CDHP population: $5,140 and $4,481, a reduction of one-eighth.
Critics of CDHPs challenge these claims in two ways. First, they assert the savings are a false economy, because the CDHP beneficiaries defer timely care because of its cost, so they end up needing more expensive care. Second, they assert selection bas: Healthier people gravitate towards CDHPs.
Although the HCCI study does not look directly at health outcomes, it does indicate these fears are ungrounded. First, CDHP beneficiaries are less likely to show up at emergency rooms than beneficiaries on traditional employer-based plans (page 8, Figure 4). This suggests the traditional beneficiaries do not do a better job at getting timely care, despite lower out-of-pocket costs. Second, 75 percent of CDHP beneficiaries submitted a claim in 2014, versus just 72 percent of traditional beneficiaries (page 20, Table 12). This close similarity suggests CDHP beneficiaries are about the same health status as traditional beneficiaries, or maybe even slightly sicker.
The cost-saving benefits of CDHPs have only begun to be achieved. Only 27 percent of the study population was covered by a CDHP. Why so few? That will be the topic of the next post.