High deductible health plans and spending among families with a substance use disorder
Research article
Overview
The United States faces an ongoing substance use crisis, with more than 20 million Americans living with a substance use disorder (SUD). The number of overdose deaths have been record-high in recent years.
As the overdose crisis has accelerated in the U.S., high deductible health plans (HDHPs) have become an increasingly prevalent product on the commercial health insurance market.
From 2016–2019, the percent of private sector enrollees in an HDHP rose from 44.4% to 53.5%.
A high deductible health plan is generally cheaper for employers, shifting some of the cost to the employees and their family. Having a deductible means that the employee needs to pay more health care costs from his or hers own pocket before the insurance company starts to pay its share. For 2022, a high deductible health plan is defined as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family.
By analysing commercial claims and enrollment data researchers identified a treatment group af enrollees whose employers began offering an HDHP, and a comparison group whose employers never offered an HDHP.
Results show that offering a family HDHP was associated with a 6.1% reduction in the probability of family members with a SUD having any SUD-related expenditures, meaning that fewer people got SUD treatment after being offered the new high deductible health plan. Researchers conclude that the rise of HDHPs may worsen the existing problem of undertreatment of substance use disorders in the US.
Abstract
Background
The United States faces an ongoing drug crisis, worsened by the undertreatment of substance use disorders (SUDs). Family enrollment in high deductible health plans (HDHPs) and the resulting increased cost exposure could exacerbate the undertreatment of SUD. This study characterized the distribution of health care spending within families where a member has a SUD and estimated the association between HDHPs and family health care spending.
Methods
Using commercial claims and enrollment data from OptumLabs (2007–2017), the researchers identified a treatment group of enrollees whose employers began offering an HDHP and comparison group whose employers never offered an HDHP.
The researchers used a difference-in-differences analysis that compared health care spending in families at firms that did vs. did not offer an HDHP before and after the HDHP offer.
All models were adjusted for employer and year fixed effects, as well as family demographics, size, and chronic conditions.
Results
The study sample was comprised of 317,353 family-years.
Family members with a SUD, on average, contributed an outsized proportion of total family health care expenditures (56.9% in a family of three).
Offering a family HDHP was associated with a 6.1% reduction in the probability of families having any SUD-related expenditures.
The HDHP offer was associated with a $1546 reduction in family total expenditures and a $1185 reduction for the individual with SUD.
Conclusions
The increased prevalence of family enrollment in HDHPs may further the existing issue of undertreatment of SUDs.