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Cost sharing: (a) High-Deductible Health Plans (moderate to high deductibles, with and without HRAs or HSAs), general patient population

Health Care: Health Care System Efficiency
  Literature review updated November 2015.
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These results are for High-Deductible Health Plans (HDHPs) versus traditional plans. These plans have moderate to high deductibles (at least a $500 individual deductible). They may or may not include health reimbursement arrangements (HRA) or a health savings account (HSA). Preventive services include cancer screening (breast, cervical, colorectal), preventive office visits, and preventive lab tests. The medication adherence effect size is for eight drug classes used to treat diabetes, high blood pressure, high cholesterol and other chronic conditions. The effect is for HDHPs where prescription drug costs are subject to the deductible.
 
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META-ANALYSIS
CITATIONS

*The effect size for this outcome indicates percentage change, not a standardized mean difference effect size.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Adjusted effect size(ES) and standard error(SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Health care costs*
Percent change in total medical costs.
0 10 5052573 -0.116 0.026 33 -0.116 0.001
Emergency department costs*
Percent change in emergency department costs.
 0 2 52058 -0.071 0.086 33 -0.071 0.407
Emergency department visits*
Whether someone visited the emergency department, or the number of times they visited the emergency department.
0 1 15847 -0.150 0.032 33 -0.150 0.001
Emergency department vists (lower-severity)*
Percent change in low-severity emergency department visits, which include visits for non-emergent problems such as upper respiratory tract infections, acute bronchitis, sore throat, and low back pain.
 0 1 15847 -0.196 0.047 33 -0.196 0.001
Emergency department visits (higher-severity)*
Percent change in high-severity emergency department visits, which include visits for emergent problems such as kidney stones, cardiac arrhythmias, acute asthma exacerbations, and open head wounds.
0 1 15847 -0.097 0.098 33 -0.097 0.323
Hospitalization*
Hospital admission, for any reason.
 0 1 15847 -0.118 0.091 33 -0.118 0.196
Prescription drug costs*
Percent change in prescription drug or pharmaceutical costs.
0 3 63193 -0.047 0.013 33 -0.047 0.001
Medication adherence
Adherence to a specific prescribed medication regimen.
0 8 4865 -0.092 0.038 33 -0.092 0.016
Preventive services
Preventive health care screening services such as mammography, cervical cancer screening, or colorectal cancer screening.
 0 11 152096 -0.046 0.010 33 -0.046 0.001
Primary care visits*
Visit to a primary care physician for any reason.
 0 1 7953 -0.090 0.015 45 -0.090 0.001

Citations Used in the Meta-Analysis

Borah, B.J., Burns, M.E., & Shah, N.D. (2011). Assessing the impact of high deductible health plans on health-care utilization and cost: a changes-in-changes approach. Health Economics, 20(9), 1025-42.

Beeuwkes, B.M., Haviland, A.M., McDevitt, R., & Sood, N. (2011). Healthcare spending and preventive care in high-deductible and consumer-directed health plans. The American Journal of Managed Care, 17(3), 222-30.

Charlton, M.E., Levy, B.T., High, R.R., Schneider, J.E., & Brooks, J.M. (2011). Effects of health savings account-eligible plans on utilization and expenditures. The American Journal of Managed Care, 17(1), 79-86.

Chen, S., Levin, R.A., & Gartner, J.A. (2010). Medication adherence and enrollment in a consumer-driven health plan. The American Journal of Managed Care, 16(2), 43-50.

Haviland, A., Sood, N., McDevitt, R., Marquis, M. (2011). How do consumer-directed health plans affect vulnerable populations? Forum for Health Economics & Policy, 14, 2.

Haviland, A., Eisenberg, M., Mehrotra, A., Huckfeldt, P. J., Sood, N., & National Bureau of Economic Research,. (2015). Do "consumer-directed" health plans bend the cost curve over time? National Bureau of Economic Research, Cambridge: MA.

Kozhimannil, K.B., Huskamp, H.A., Graves, A.J., Soumerai, S.B., Ross-Degnan, D., & Wharam, J.F. (2011). High-deductible health plans and costs and utilization of maternity care. The American Journal of Managed Care, 17(1), 17-25.

Lo, S.A.T., Shah, M., & Frogner, B.K. (2010). Health savings accounts and health care spending. Health Services Research, 45(4), 1041-1060.

Reddy, S.R., Ross-Degnan, D., Zaslavsky, A.M., Soumerai, S.B., & Wharam, J.F. (2014). Impact of a high-deductible health plan on outpatient visits and associated diagnostic tests. Medical Care, 52(1), 86-92.

Reiss, S.K., Ross-Degnan, D., Zhang, F., Soumerai, S. B., Zaslavsky, A.M., & Wharam, J.F. (2011). Effect of switching to a high-deductible health plan on use of chronic medications. Health Services Research, 46(5), 1382-401.

Wharam, J.F., Landon, B.E., Zhang, F., Soumerai, S.B., & Ross-Degnan, D. (2011). High-deductible insurance: two-year emergency department and hospital use. The American Journal of Managed Care, 17(10), 410-8.

Wharam, J.F., Graves, A.J., Landon, B.E., Zhang, F., Soumerai, S.B., & Ross-Degnan, D. (2011). Two-year trends in colorectal cancer screening after switch to a high-deductible health plan. Medical Care, 49(9), 865-71.

Wharam, J.F., Graves, A.J., Zhang, F., Soumerai, S.B., Ross-Degnan, D., & Landon, B.E. (2012). Two-year trends in cancer screening among low socioeconomic status women in an HMO-based high-deductible health plan. Journal of General Internal Medicine, 27(9), 1112-9.