High-deductible health plans are linked to fewer ER visits

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, 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 nonemergency 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.

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