How Do High-Deductible Health Plans Affect Use of Health Care Services and Spending Among Enrollees With Mental Health Disorders?

Summary

In this paper, we explore the impact of moving from a preferred provider organization (PPO) to a high-deductible health plan (HDHP) among people with mental health disorders.  We focus on individuals with major depressive disorder (MDD), anxiety, and attention deficit hyperactivity disorder (ADHD) since these represent the majority of mental health patients.  Furthermore, the prevalence of these conditions in the population with employment-based health insurance is especially high relative to other mental health conditions, and it has been increasing.  In our analysis, we observe:

• Moving from a PPO to an HDHP reduced the probability of using health care services.
• The amount of health services used was also lower among patients with mental health disorders who moved from a PPO to an HDHP.  Office visits, prescription drug fills, inpatient days, and emergency department visits all declined.
• Utilization of preventive services including cancer screenings and some vaccinations was also negatively affected by the move from a PPO to an HDHP.
• The reductions in use of health care services prompted declines in overall health care spending.  Employer spending fell by a greater amount and percentage than overall spending.  Employee spending increased because the move from the PPO to the HDHP shifted some pre-deductible spending onto users of health care.
• Moving from a PPO to an HDHP had a mixed impact on use of out-of-network health care services.  While the probability of using an out-of-network mental health provider fell among those with ADHD and MDD, neither the number of office visits nor overall spending on out-of-network care were affected by the plan change.

When employers raise deductibles, they do so to better manage their costs.  They are trying to balance their efforts to reduce low-value health care services while incentivizing the use of high-value services.  Our findings are limited by the fact that outcomes related to changes in health care use during the switch from PPO to HDHP are unobserved. Such outcomes would ultimately be impacted by the value of care received, for which data is unavailable for this analysis.

Our research can help employers make targeted benefit design decisions.  They can also inform policymakers as they consider allowing employers to provide enhanced coverage for health care services that prevent the exacerbation of chronic conditions.