EBRI Issue Brief

Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use of Low-Value Health Care Services

Oct 22, 2020 11  pages


The use of high health plan deductibles is an increasingly common strategy to enhance health care consumerism and lower health care spending.  Proponents speculate that high levels of cost sharing enhance consumers’ tendency to discriminate between high- and low-value care.  In other words, cost sharing is a tool for teaching members to “choose wisely” throughout the plan year when it comes to the services they use. But does this work?

In this study, we examine the extent to which members who satisfy their plan deductible continue to discriminate when it comes to services used.  To quantify whether deductibles help patients learn to “choose wisely” and avoid low-value care once deductibles have been met, we compared the use of six commonly overutilized imaging, screening, and pre-surgery testing services among 1.5 million individuals enrolled in commercial health plans with a deductible who had, and had not, satisfied the deductible. 

We found that the likelihood of receiving low-value health care services increased by as much as 83 percent, depending on the service, for those who had satisfied their plan’s deductible relative to those who had not.  We also examine cancer screenings and find that use of these screenings is higher among those who do not meet the age recommendations once deductibles are met.  Strategies in addition to high plan deductibles may be needed to reduce the use of low-value care.