Reports of the Effects of CDHC Plans a Mixed Bag

October 26, 2006 ( - An article published in the Journal of Health Affairs, details a mixed picture on the effects of Consumer-Directed Health Care plans (CDHC) on health care cost and quality.

According to the article, studies that have used the RAND Health Insurance Experiment (HIE) results to simulate the effects of moving the population from other employer-sponsored health plans to a plan with a high-deductible, such as a CDHC plan, suggest there would be a reduction in health care spending of 4% to 15%. Other studies have indicated more modest reductions in health care costs for consumers, even noting that high health care spenders would actually see an increase in spending due to a reduction in cost-sharing by employers.

In addition, studies have indicated that the popular trend of coupling a CDHC plan with a health savings account (HSA) or health reimbursement account (HRA) can offset the reduction in spending gained from a CDHC plan alone, the article said. Estimates are that the addition of a HSA or HRA would cut the 4% – 15% reduction in health care spending in half.

The study authors point out that, in general, reports on the effects of CDHC plans have supported the RAND HIE’s conclusion that these plans reduce consumer health care use and spending. Estimates have also indicated a health care cost savings to employers of 10% – 25% (See Mercer: CDHP’s Save Employers $$$ ). However, the article points out that some reports are not clear on whether the savings is due to a mere cost-shift to employees or a real spending reduction.

Reports on the effects of CDHC plans on quality of health care have also been mixed. While one of the intentions of CDHC plans is to encourage individuals to reduce unnecessary and inappropriate use of health care, the RAND HIE found a reduction in both health care that is considered necessary and unnecessary care. Forgoing needed medical care can result in greater health costs in the long run.

Other studies report increased use of preventive care and increased compliance with prescribed medical treatment of individuals with CDHC plan coverage, the article said. Additionally, evidence has suggested that many CDHC plans include incentives for employees to participate in various wellness initiatives.

Employee satisfaction is also an indicator of quality, and reports have indicated that employees in CDHC plans are less satisfied with the quality of health care they receive than employees in other plan types (See Survey Finds Low Satisfaction with Consumer-Driven Health Plans ). Reports have also shown that employees in CDHC plans report being more satisfied when they were covered under another plan type previously.

The article Consumer Directed Health Care: Early Evidence About Effects on Cost and Quality can be viewed here .