News Release

High-deductible health plans linked to fewer emergency room visits

Authors stress that further investigation is needed to ensure that patients are not deferring necessary care

Peer-Reviewed Publication

Harvard Medical School

BOSTON -- Patients who switched to high-deductible health plans went to the emergency department 10 percent less than patients who remained in traditional plans, according to a new study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). The study, published in the March 14 Journal of the American Medical Association, shows that most of this reduction was for less severe conditions like colds, nausea, and headaches. The authors followed members for approximately one year after the switch to the high-deductible plan.

“Our study showed that for most members, the high-deductible plan seemed to work as intended,” said Frank Wharam, MD, MPH, research fellow in the Department of Ambulatory Care and Prevention and the study’s lead author. “Patients went to the emergency room less frequently for non-emergency conditions.”

However, the authors stress that more research is needed to determine long-term health consequences and the impact on different segments of the population. “It will be important to determine how the health of low income and chronically ill patients is affected,” said Wharam. “Our study could not provide conclusive answers. Ideally, high-deductible plans will be structured so that all patients readily seek care when they think they have an emergency.”

High-deductible health plans are playing a central role in Massachusetts health insurance reform efforts. Nationwide, they have become increasingly popular as a way to stem rising health care costs and make insurance more affordable to individuals and employers. Monthly premiums are lower than traditional health insurance plans but enrollees must pay for most medical services up to a deductible amount that averages $1,000 to $4,000 per year. Emergency department visits and hospitalizations are often subject to the deductible.

The study compared approximately 60,000 members enrolled in a traditional health insurance plan in Massachusetts with more than 8,700 members working for employers who switched to offering only a high-deductible plan. The high-deductible plans studied were not federally qualified high-deductible health plans (a.k.a. HSA plans) because office visits and prescription drugs were not subjected to the deductible. The researchers examined patients’ emergency department diagnoses to determine the effect on visits for high severity conditions (like asthma or kidney stones) and low severity conditions (like headaches, nausea, or colds).

There was a slight decline in first-time emergency visits for members in high deductible plans and a 25 percent reduction in repeat visits, mostly for non-severe conditions. This suggests that when members realize their responsibility for out-of-pocket expenses, they reduce future emergency department visits for less urgent conditions. Patients in the high-deductible plans were also hospitalized less as a result of both reduced emergency visits and fewer admissions once reaching the emergency department.

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FOR MORE INFORMATION, PLEASE CONTACT:
Sharon Torgerson, Harvard Pilgrim, 617-509-7458, sharon_torgerson@hphc.org

This work was supported by the Harvard Pilgrim Health Care Foundation.

HARVARD MEDICAL SCHOOL
http://hms.harvard.edu/

Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, VA Boston Healthcare System.

HARVARD PILGRIM HEALTH CARE
http://www.hphc.org

Harvard Pilgrim Health Care is a not-for-profit health care plan operating in Massachusetts, New Hampshire, and Maine with more than one million members. Harvard Pilgrim was the first New England health plan to establish a non-profit foundation with the sole purpose of serving the community at large. The efforts of the foundation reflect Harvard Pilgrim’s mission, which is to improve the health of its members and the health of society.


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