A new research report suggests that consumer-directed health plans — which give employees more control over how they spend their employer-subsidized health care dollars — are getting the opposite of the results intended.
In a five-year study, researchers found a tendency over time for employees in a consumer-directed plan to spend less on preventive care appointments and use emergency rooms more than employees in a more traditional preferred provider organization plan.
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The report, released this week by the Employee Benefit Research Institute, compared the health care experience of employees in two large companies. One company’s employees were enrolled in a health savings account, a type of consumer-directed health plan. The other company’s employees were in a more traditional preferred provider organization plan.
Consumer-directed health plans were introduced with the expectation that employees would be more health and spending conscious if they had more direct control over how they spent their health care dollars.
Such plans include high-deductibles along with tax-preferred savings or spending accounts that allow employees to save up contributions over time. The theory is that as employees spend their deductibles, they will make careful health care decisions, as they will when they draw from their health savings accounts.
The study compared 13,278 employees and dependents in the consumer-directed plan with 10,509 employees and dependents in a preferred provider plan, matching population characteristics to compare like individuals.
The conclusion: On a statistically significant basis, the health savings account users had fewer physician office visits and filled fewer prescriptions but had more emergency department visits.
“This is contrary to expectations,” the report said. “The increase in (emergency department) use might stem from the long-term implications of reductions in physician office visits and prescription drug use after the (consumer-directed health plan) was implemented.
“Fewer physician office visits may lead to the writing of fewer prescriptions, which could in turn mean that individuals with chronic conditions are less adherent to recommended medication therapy.”
Since one goal of consumer-directed health plans is to increase health awareness and preventive care, the study authors suggested that employers need to ramp up consumer education about the importance of health screenings. Also, plans could be designed to exempt certain preventive services from the deductible.