Cameron J Schilling1, Matthew D Eisenberg1, Alene Kennedy-Hendricks1, Alisa B Busch1, Haiden A Huskamp1, Elizabeth A Stuart1, Mark K Meiselbach1, Colleen L Barry1. 1. Department of Health Policy and Management (Schilling, Eisenberg, Kennedy-Hendricks, Stuart, Meiselbach, Barry), Johns Hopkins Center for Mental Health and Addiction Policy (Schilling, Kennedy-Hendricks, Barry), and Department of Mental Health (Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; OptumLabs Visiting Fellow, OptumLabs, Eden Prairie, Minnesota (Eisenberg); Department of Health Care Policy, Harvard Medical School, Boston (Busch, Huskamp); McLean Hospital, Belmont, Massachusetts (Busch).
Abstract
OBJECTIVE: High-deductible health plans (HDHPs) are increasingly common in the U.S. health insurance market and are intended to reduce the use of low-value services, but evidence suggests that HDHP enrollees also reduce the use of high-value services. This study examined the effects of HDHPs on enrollees with mental health conditions, a population with high levels of unmet treatment need, often because of financial barriers. Enrollees with a co-occurring substance use disorder have greater treatment needs and unique barriers to care, perhaps changing their response to an HDHP. METHODS: Commercial health insurance claims data in a difference-in-differences design was used to evaluate the effect of an employer's offer of an HDHP on 6,627,128 enrollee-years among enrollees with mental health conditions, stratified by having a co-occurring substance use disorder or not. RESULTS: Among enrollees without a co-occurring substance use disorder, an HDHP offer was associated with a 4.8% (95% confidence interval [CI]=2.4%-7.2%) reduction in overall spending on mental health care, despite an 11.3% (95% CI=1.0%-21.6%) increase in spending on mental health-related emergency department visits. Among enrollees with a co-occurring substance use disorder, no significant changes attributable to an HDHP offer were found in most categories of spending on combined mental health and substance use disorder care, apart from a 4.5% (95% CI=1.9%-7.2%) reduction in spending on psychotropic medications. CONCLUSIONS: HDHPs may reduce use of necessary care among enrollees with mental health conditions, which could exacerbate undertreatment in this population and result in adverse health outcomes.
OBJECTIVE: High-deductible health plans (HDHPs) are increasingly common in the U.S. health insurance market and are intended to reduce the use of low-value services, but evidence suggests that HDHP enrollees also reduce the use of high-value services. This study examined the effects of HDHPs on enrollees with mental health conditions, a population with high levels of unmet treatment need, often because of financial barriers. Enrollees with a co-occurring substance use disorder have greater treatment needs and unique barriers to care, perhaps changing their response to an HDHP. METHODS: Commercial health insurance claims data in a difference-in-differences design was used to evaluate the effect of an employer's offer of an HDHP on 6,627,128 enrollee-years among enrollees with mental health conditions, stratified by having a co-occurring substance use disorder or not. RESULTS: Among enrollees without a co-occurring substance use disorder, an HDHP offer was associated with a 4.8% (95% confidence interval [CI]=2.4%-7.2%) reduction in overall spending on mental health care, despite an 11.3% (95% CI=1.0%-21.6%) increase in spending on mental health-related emergency department visits. Among enrollees with a co-occurring substance use disorder, no significant changes attributable to an HDHP offer were found in most categories of spending on combined mental health and substance use disorder care, apart from a 4.5% (95% CI=1.9%-7.2%) reduction in spending on psychotropic medications. CONCLUSIONS: HDHPs may reduce use of necessary care among enrollees with mental health conditions, which could exacerbate undertreatment in this population and result in adverse health outcomes.
Entities:
Keywords:
Economics; Insurance; Mental illness and alcohol/drug abuse
Authors: Elizabeth Reisinger Walker; Janet R Cummings; Jason M Hockenberry; Benjamin G Druss Journal: Psychiatr Serv Date: 2015-03-01 Impact factor: 3.084
Authors: Amelia M Haviland; Matthew D Eisenberg; Ateev Mehrotra; Peter J Huckfeldt; Neeraj Sood Journal: J Health Econ Date: 2016-01-14 Impact factor: 3.883
Authors: Colleen L Barry; Elizabeth A Stuart; Julie M Donohue; Shelly F Greenfield; Elena Kouri; Kenneth Duckworth; Zirui Song; Robert E Mechanic; Michael E Chernew; Haiden A Huskamp Journal: Health Aff (Millwood) Date: 2015-12 Impact factor: 6.301
Authors: J Frank Wharam; Alisa B Busch; Jeanne Madden; Fang Zhang; Matthew Callahan; Robert F LeCates; Phyllis Foxworth; Stephen Soumerai; Dennis Ross-Degnan; Christine Y Lu Journal: Am J Manag Care Date: 2020-06 Impact factor: 2.229
Authors: Alene Kennedy-Hendricks; Cameron J Schilling; Alisa B Busch; Elizabeth A Stuart; Haiden A Huskamp; Mark K Meiselbach; Colleen L Barry; Matthew D Eisenberg Journal: J Gen Intern Med Date: 2021-08-17 Impact factor: 5.128