The impact of telehealth cost-sharing on healthcare utilization: Evidence from high-deductible health plans.
cost‐sharing
high‐deductible health plans
telehealth
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
13 Aug 2024
13 Aug 2024
Historique:
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
13
8
2024
Statut:
aheadofprint
Résumé
Evaluate whether cost-sharing decreases led high-deductible health plans (HDHP) enrollees to increase their use of healthcare. National sample of chronically-ill patients age 18-64 from 2018 to 2020 (n = 1,318,178). Difference-in-differences analyses using entropy-balancing weights were used to evaluate the effect of a policy shift to $0 cost-sharing for telehealth on utilization for HDHP compared with non-HDHP enrollees. Due to this shock, HDHP enrollees experienced substantial declines in cost-sharing for telehealth, while non-HDHP enrollees experienced small declines. Event study models were also used to evaluate changes over time. Outcomes included use of any outpatient care; use of $0 telehealth; use of $0 telehealth as a proportion of all outpatient care; and use of any telehealth. To test whether any differences were due to preferences for care modality versus cost-sharing, we further evaluated use of non-$0 telehealth as a placebo test. There was no difference in change in overall outpatient visits (p = 0.84), with chronicall-ill HDHP enrollees using less care both before and after the policy shift. However, compared with non-HDHP enrollees, HDHP enrollees increased their use of $0 telehealth by 0.08 visits over a 9-month period, a 27% increase (95% CI 0.07-0.09, p < 0.001) and shifted 1.2 percentage points more of their care to $0 telehealth, a 15% increase (ß = 0.01, 95% CI 0.01, 0.01, p < 0.001). However, HDHP enrollees had lower uptake of non-$0 telehealth than non-HDHP enrollees (ß = -0.01, 95%CI -0.02, 0.00, p = 0.04). Recent-but-expiring federal legislation exempts telehealth from HDHP deductibles for care provided in 2023 and 2024. Our results indicate that extending the protections provided by this legislation could help reduce the gap in access to care for chronically-ill persons enrolled in HDHPs.
Identifiants
pubmed: 39135532
doi: 10.1111/1475-6773.14343
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIA NIH HHS
ID : R01AGO72057
Pays : United States
Informations de copyright
© 2024 RAND Corporation and The Author(s). Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.
Références
Cohen RA, Martinez M, Zammitti EP. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey. January–March 2018 2018 https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201808.pdf
Fronstin P, Sepulveda MJ, Roebuck MC. Medication utilization and adherence in a health savings account‐eligible plan. Am J Manag Care. 2013;19(12):e400‐e407.
Haviland A, Sood N, McDevitt R, Marquis M. How do consumer‐directed health plans affect vulnerable populations? Forum Health Econ Policy. 2011;14(2):1‐12. doi:10.2202/1558‐9544.1248
Brot‐Goldberg Z, Chandra A, Handel B, Kolstad J. What does a deductible do? The impact of cost‐sharing on health care prices, quantities, and spending dynamics. Q J Econ. 2015;132(3):1261‐1318.
Beeuwkes Buntin M, Haviland AM, McDevitt R, Sood N. Healthcare spending and preventive care in high‐deductible and consumer‐directed health plans. Am J Manag Care. 2011;17(3):222‐230.
Wharam JF, Lu CY, Zhang F, et al. High‐deductible insurance and delay in care for the macrovascular complications of diabetes. Ann Intern Med. 2018;169(12):845‐854. doi:10.7326/M17‐3365
Newhouse JP. Insurance experiment group. Free for all? Lessons from the RANDHealth Insurance Experiment. 1993.
Rabideau B, Eisenberg MD, Reid R, Sood N. Effects of employer‐offered high‐deductible plans on low‐value spending in the privately insured population. J Health Econ. 2021;76:102424. doi:10.1016/j.jhealeco.2021.102424
Fendrick AM, Buxbaum JD, Tang Y, et al. Association between switching to a high‐deductible health plan and discontinuation of type 2 diabetes treatment. JAMA Netw Open. 2019;2(11):e1914372. doi:10.1001/jamanetworkopen.2019.14372
Jiang DHMB, Shah ND, McCoy RG. Impact of high deductible health plans on diabetes care quality and outcomes: systematic review. Endocr Pract. 2022;27(11):1156‐1164.
Eisenberg MD, Haviland AM, Mehrotra A, Huckfeldt PJ, Sood N. The long term effects of “consumer‐directed” health plans on preventive care use. J Health Econ. 2017;55:61‐75. doi:10.1016/j.jhealeco.2017.06.008
Galbraith AA, Ross‐Degnan D, Soumerai SB, Rosenthal MB, Gay C, Lieu TA. Nearly half of families in high‐deductible health plans whose members have chronic conditions face substantial financial burden. Health Aff (Millwood). 2011;30(2):322‐331. doi:10.1377/hlthaff.2010.0584
Galbraith AA, Soumerai SB, Ross‐Degnan D, Rosenthal MB, Gay C, Lieu TA. Delayed and forgone care for families with chronic conditions in high‐deductible health plans. J Gen Intern Med. 2012;27(9):1105‐1111. doi:10.1007/s11606‐011‐1970‐8
Garabedian LF, Zhang F, LeCates R, Wallace J, Ross‐Degnan D, Wharam JF. Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a natural experiment for translation in diabetes (NEXT‐D2) study. BMJ Open. 2021;11(9):e044198. doi:10.1136/bmjopen‐2020‐044198
Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States. 2017:1 online resource (33 pages). ISBN 9780833097378 ISBN 0833097377 https://www.rand.org/pubs/tools/TL221.html
Internal Revenue Service Health Savings Accounts and Other Tax‐Favored Health Plans. Internal Revenue Service. 2017.
American Medical Association. Telehealth Services Covered by Medicare and Included in CPT Code Set. American Medical Association. 2019. Accessed May 3, 2023. https://www.ama-assn.org/system/files/telehealth-services-covered-by-medicare-and-included-in-cpt-code-set.pdf
Selden TM, Berdahl TA. COVID‐19 and racial/ethnic disparities in health risk, employment, and household composition. Health Aff (Millwood). 2020;39(9):1624‐1632.
Selden TM, Berdahl TA. Risk of severe COVID‐19 among workers and their household members. JAMA Intern Med. 2020;181(1):120‐122.
Zeldow B, Hatfield LA. Confounding and regression adjustment in difference‐in‐differences studies. Health Serv Res. 2021;56(5):932‐941. doi:10.1111/1475‐6773.13666
Hainmueller J. Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Political Analysis. 2012;20(1):25‐46.
Huang MYVB, Burgette LF, Setodji C, Griffin BA. Higher moments matter for optimal balance weighting in causal estimation. Epidemiology. 2022;33(4):551‐554.
Setodji CM, McCaffrey DF, Burgette LF, Almirall D, Griffin BA. The right tool for the job: choosing between covariate‐balancing and generalized boosted model propensity scores. Epidemiology. 2017;28(6):802‐811. doi:10.1097/EDE.0000000000000734
Abadie A, Athey S, Imbens G, Wooldridge J. When should you adjust standard errors for clustering? Q J Econ. 2023;138(1):1‐35.
Maas CJM, Hox JJ. The influence of violations of assumptions on multilevel parameter estimates and their standard errors. Comput Stat Data Anal. 2004;46(3):427‐440.
Gould E, Schieder J, Geier K. What Is the Gender Pay Gap and Is it Real? 2016.
Gidwani R, Uscher‐Pines L, Kofner A, Whaley CM. Differences in telehealth during COVID‐19 between commercial and Medicaid enrollees. Am J Manag Care. 2023;29(1):19‐26. doi:10.37765/ajmc.2023.89300
Mehrotra A, Chernew ME, Linetsky D, Hatch H, Cutler DM, Schneider EC. The Impact of COVID‐19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases 2021. https://www.commonwealthfund.org/publications/2021/feb/impact-covid-19-outpatient-visits-2020-visits-stable-despite-late-surge
Fihn SD, Gardin JM, Abrams J, et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, preventive cardiovascular nurses association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354‐e471. doi:10.1161/CIR.0b013e318277d6a0
National Heart, Lung, and Blood Institute (US). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Report No.: 04–5230. 2004.
American Diabetes Association. American Diabetes Association, standards of medical Care in Diabetes—2015. Diabetes Care. 2015;38(Suppl. 1):S1‐S2.
National Heart, Lung, and Blood Institute (US). Guidelines for the Diagnosis and Management of Asthma 2007 (EPR‐3). 2012.