Patients who switched to a high-deductible health plan (HDHP) cut their emergency department use by 10 percent, compared to a control group comprising members with traditional coverage, according to a study from Harvard Medical School and Harvard
Pilgrim Health Care. There was a slight decline in first-time emergency visits for members in high-deductible plans, but a 25 percent reduction in repeat visits, mostly for nonsevere conditions. Further, the HDHP group was hospitalized less, as a result of both reduced emergency visits and fewer admissions once reaching the emergency department.
Researchers analyzed emergency department visits and subsequent hospitalizations for 8,724 individuals for one year before and after their employers switched from an HMO to an HDHP. The control group was made up of 55,557 members who remained in the HMO.
"For most members, at least in our population, these plans are working as intended," says J. Frank Wharam, MPH, the study's lead author. "Patients reduced emergency department visits for non-emergency conditions."
Earlier studies, including the Rand Health Insurance Experiment conducted more than 30 years ago, have demonstrated that making health care more expensive to the member drives down the use of hospitals, medications, and preventive services.
The new study came to a different conclusion: "Most HDHP members did not forgo high-severity emergency department visits and seemed able to distinguish low-severity conditions not requiring emergency department care," says Wharam. "But we did find trends, in those lower-income area residents, towards reductions in visits for high-severity conditions. That could point to worrisome patterns of use, but we would need bigger studies and longer follow up to make any definitive conclusions."